CMS Expands Eligibility Criteria for Primary Care Bonus

The Centers for Medicare and Medicaid Services (CMS) has modified the eligibility criteria for the primary care bonus established by the Affordable Care Act (P.L. 111-148), ensuring that a larger percentage of family physicians and general internists will qualify for the bonus.

At the urging of the AOA and other primary care associations, CMS will limit the eligibility denominator to Medicare Fee Schedule allowed charges only -- meaning it will exclude lab services and other charges.  Hospital visits will also be subtracted from the denominator. With these changes, CMS estimates that 80% of family physicians and 60% of general internists will qualify for the 10% bonus payment.