Update to the Primary Care Incentive Payment Program for CAH Providers Paid Under Optional Method

On Tue Nov 15, 2011, CMS issued a listserv message with billing instructions for CAHs)paid under the Optional Method regarding the Primary Care Incentive Payment (PCIP) Program. The message instructed CAH providers to continue submitting their National Provider Identifiers (NPIs) using the “other provider” field located in loop 2310C on the current electronic claim format. After further research, CMS has determined that, in addition to reporting the NPI in loop 2310C, CAH providers will need to report the same NPI as well as the information that is required in loop 2310B defined as “operating physician.” This will ensure CAH claims submitted using the Accredited Standards Committee (ASC X12) version 5010A2 will continue to receive their PCIP bonus without any interruption. Change Request 7686 has been created and will be implemented by contractors to update the Medicare systems to assign the PCIP bonus payments based on the NPI from loop 2310D, “rendering physician.” However, until the successful implementation of CR7686 – expected to take place in July – the reporting of the NPI for the PCIP bonus payments should continue as described above.