Contractor Warns of Incorrect Use of AQ Modifier

Confusion regarding which services qualify for the Health Professional Shortage Area (HPSA) 10 percent bonus is mounting, Palmetto GBA says. “Submitting HPSA modifiers on claims that do not qualify for the HPSA incentive payment may result in erroneous incentive payments and a referral to the Zone Program Integrity Contractor (ZPIC) for fraud and abuse investigation,” the Medicare contractor warns.

To curtail abuse, Palmetto says it will be “suppressing” HPSA payments for providers with four or more quarters of erroneous billing of the AQ modifier.

Palmetto also posted important HPSA claim filing rules and requirements on its website, with a reminder, “It is vital that you determine whether the service qualifies for a HPSA bonus payment prior to submitting a claim.”

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