Health Professional Shortage Area (HPSA) & Physician Scarcity Area (PSA) Appeal Requests
If a physician receives a HPSA/PSA bonus payment and he does not agree with the payment determination, he can request an appeal. The request must be filed within 60 days after receipt of the bonus payment.
Occasionally, physicians neglect to add the appropriate modifier (AR, AQ, QU or QB) to services eligible for the HPSA/PSA payment. This would be for HPSA/PSA eligible areas that are not on the automated zip code file.
A physician may request that Medicare reopen the claims to add the appropriate modifier. The request can be submitted for up to one year from the date on the remittance notice.
Before submitting a request to add the HPSA/PSA modifier, please contact our office to verify that the area in question is designated as a HPSA/PSA and a modifier is necessary.
After verifying that the services are eligible for the bonus payment, submit copies of the remittance notices for the services in question. Indicate the claims in question on the remittance notices.
Attach a cover letter requesting that Medicare review the claims in question. Include the modifier to be used and the complete street address, city, state and zip of the location where the services were rendered.
Please do not include claims that were denied or no payment was made (example: full amount applied to patient's deductible). The bonus payment is based on the Medicare paid amount. No payment was made on these claims; therefore, no bonus payment can be made.
Medicare will verify that the services are eligible for a bonus payment, reopen the claims with eligible services and add the appropriate modifier. The bonus payment will be issued with the next quarterly bonus payment after your request is complete.
To appeal your bonus payment, verify services are eligible for a bonus payment or request that the HPSA/PSA modifier be added to claims, please click here for Medicare Part B contact information.
Page Last Updated: Monday, 09-Jun-2008 13:34:15 CDT
