Only Eligible Providers Can Qualify for Bonus Payments

Only network and non-network physicians (M.D.s and D.O.s), podiatrists, oral surgeons, and optometrists who qualify for Medicare Bonus Payments in Health Professional Shortage Areas (HPSA) are eligible for a 10-percent bonus payment for claims submitted to TRICARE.

The only behavioral health providers eligible for HPSA bonus payments are M.D.s and D.O.s. Non-physician providers (Ph.D.s, social workers, counselors, psychiatric nurse practitioners and marriage therapists) are not eligible.

In addition, network and non-network primary care physicians (general practitioners, family physicians, internists, and OB/GYNs) who qualify for Medicare Bonus Payments in Physician Scarcity Areas may also be eligible for a 5-percent bonus payment for claims submitted on or after January 1, 2005. The 5-percent bonus payment does not apply to podiatrists, oral surgeons, and optometrists.

Providers can determine if they are in an HPSA by accessing the U.S. Department of Health and Human Services, Bureau of Health Professions’ HPSA search tool at http://hpsafind.hrsa.gov. There is also bonus payment information, including HPSA and Physician Scarcity Area designations, on the Centers for Medicare and Medicaid Services (CMS) Web site at www.cms.hhs.gov/providers/bonuspayment/.