Payments ending for CMS Primary Care Incentive Program (PCIP)

The Affordable Care Act authorized a quarterly incentive payment program to augment the Medicare payment for primary care services when furnished by primary care practitioners beginning in 2011 and ending in 2015. 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, were eligible for the incentive payment if primary care services (CPT codes 99201through 99215 and 99304 through 99350) accounted for at least 60 percent of the practitioner’s total allowed charges under the physician fee schedule in the qualifying calendar year. The PCIP program provided a 10 percent incentive payment for primary care practitioners, and the HSIP provided a 10 percent incentive payment for general surgeons

Both the PCIP and the HPSA Surgical Incentive Program (HSIP) are expected to decline as the number of claims submitted by relevant providers for 2015 steadily declines. The estimated impact on Starling Physicians is approximately $150,000 a year or $4,000 per eligible PCP.