Q: What do critical access hospitals (CAHs) who have elected Method II have to provide to their fiscal intermediary (FI) to help determine eligibility for the primary care and specialty bonus?

Q: What do critical access hospitals (CAHs) who have elected Method II have to provide to their fiscal intermediary (FI) to help determine eligibility for the primary care and specialty bonus?

A: Critical access hospitals (CAHs) that have elected Method II for payment of outpatient services should supply their fiscal intermediary (FI) with a list of their physicians, by specialty, that have reassigned their payment to the CAH. Your FI will determine which physicians are eligible for the primary care bonus and which should receive the specialty bonus. A Healthcare Common Procedure Coding System (HCPCS) code accompanying the AG modifier denotes a primary physician, and one with the AF modifier denotes a specialty physician.

Remember that FIs will only pay the bonus for primary care designations of General Practice, Family Practice, Internal Medicine, and Obstetrics/Gynecology, for the zip codes designated as primary care scarcity areas. The FIs will only pay the bonuses for physician provider specialties, other than Oral Surgery (dentists only), Chiropractic, Optometry, and Podiatry, for the zip codes designated as specialty physician scarcity areas. Quarterly payments should be made to CAHs, where applicable, one month after the close of a quarter.

Source: Centers for Medicare and Medicaid Services