CMS Pub. 100-04, ch. 12, § 230.3

A. General Overview

Incentive payments will be made on a quarterly basis and shall be equal to 10 percent of

the amount paid for such services under the Medicare Physician Fee Schedule (PFS) for

those services furnished during the incentive payment year. PCIP payments for newly

enrolled practitioners will be delayed due to the lag in their eligibility determination.

Newly enrolled primary care practitioners will receive a single cumulative PCIP

payment, retroactive for primary care services furnished from the beginning of the PCIP

payment year, following the fourth quarter of the PCIP payment year after the primary

care practitioner is deemed eligible. Quarterly payments will be made for subsequent

incentive payments.

For information on PCIP payments to CAHs paid under the optional method, see the

Medicare Claims Processing Manual, Pub. 100-04, Chapter 4, §250.12.

On an annual basis A/B MACs (B) shall receive a Primary Care Incentive Payment

Program Eligibility File and PCIP Payment for New Providers Enrolled in Medicare File

that they shall post to their websites. The files will list the NPIs of all practitioners who

are eligible to receive PCIP payments for the PCIP payment year.

B. Method of Payment

• Calculate and pay qualifying primary care practitioners an additional 10 percent

incentive payment.

• Calculate the payment based on the amount actually paid for the services, not the

Medicare approved amount.

• Combine the PCIP incentive payments, when appropriate, with other incentive

payments, including the HPSA physician bonus payment, and the HPSA Surgical

Incentive Payment Program (HSIP) payment;

• Provide a special remittance form that is forwarded with the incentive payment so

that physicians and practitioners can identify which type of incentive payment

(HPSA physician and/or PCIP) was paid for which services.

• Practitioners should contact their A/B MAC (B) with any questions regarding

PCIP payments.

C. Changes for Contractor Systems

The Medicare Carrier System, (MCS), Common Working File (CWF) and the National

Claims History (NCH) shall be modified to accept a new PCIP indicator on the claim

line. Once the type of incentive payment has been identified by the shared systems, the

shared system shall modify their systems to set the indicator on the claim line as follows:

1 = HPSA;

2 = PSA;

3 = HPSA and PSA;

4 = HSIP;

5 = HPSA and HSIP;

6 = PCIP;

7 = HPSA and PCIP; and

Space = Not Applicable.

The MCS shall send the HIGLAS 810 invoice for incentive payment invoices, including

the new PCIP payment. The A/B MAC (B) shall also combine the provider’s HPSA

physician bonus, physician scarcity (PSA) bonus (if it should become available at a later

date), HSIP payment and/or PCIP payment invoice per provider. The A/B MAC (B)

shall receive the HIGLAS 835 payment file from HIGLAS showing a single incentive

payment per provider.