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2012 Primary Care Incentive Payments Top $664 Million
Practitioners whose billings comprise ≥60 percent of total Medicare allowed charges are eligible

TUESDAY, Aug. 13 (HealthDay News) -- Payments from the Medicare Primary Care Incentive Payment Program (PCIP) were more than $664 million for calendar year 2012, according to a report published by the Centers for Medicare & Medicaid Services (CMS).

According to the Affordable Care Act, primary care practitioners with a Medicare specialty designation of family medicine, geriatric medicine, pediatric medicine, internal medicine, nurse practitioner, clinical nurse specialist, or physician assistant are eligible for the incentive program from 2011 to 2015 to augment Medicare payment for primary care services. Practitioners whose primary care services accounted for 60 percent or more of their total allowed charges under the physician fee schedule for a given year are considered eligible.

CMS uses Medicare claims data from the calendar year two years before the PCIP incentive payment to calculate a practitioner's primary care percentage. When calculating the practitioner's total allowed charges, emergency, hospital inpatient, drug, and laboratory charges are excluded. The incentive payments equal 10 percent of the Medicare paid amount for primary care services, and were more than $664 million for eligible practitioners for calendar year 2012.

"Incentive payments are equal to 10 percent of the Medicare paid amount for primary care services," according to the report. "Quarterly incentive payments are made to individual physicians, non-physician practitioners, group practices, and Method II critical access hospitals billing for practitioners."

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April 24, 2014

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