This document outlines the agenda and details of a webinar on Michigan's Primary Care Transformation Demonstration Project. It discusses patient identification and eligibility, funding sources, care manager training requirements, payment policies, billing guidelines, and general program delivery conditions. Practices and physician organizations will be paid for providing care management services including assessments, individual/group visits, and phone calls performed by qualified staff like nurses and social workers.
This document provides information about payment policies and billing guidelines for primary care transformation services through Michigan's Primary Care Transformation Demonstration Project. It discusses payment rates and codes for services like care management visits, group visits, and telephone consultations. Requirements are outlined for care management teams, eligible patients, documentation, and billing. Updates are provided from Blue Cross Blue Shield of Michigan and Blue Care Network on their payment policies and requirements.
This document discusses Michigan's Primary Care Transformation Demonstration Project. It outlines the agenda for webinar #10, including discussions on Medicaid and Medicare payments, care managers, project committees and metrics. It then provides details on performance metrics and incentives, care manager roles, clinical quality measures, and expectations for participating medical organizations. The webinar aims to update practices on the project and support development of patient-centered medical home capabilities.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
This document discusses quality reporting incentives from CMS and their impact on physician practices. It outlines the requirements and incentives for three separate CMS programs - Meaningful Use, PQRS, and e-Prescribing. Participation in these programs can provide incentives, but failure to participate may result in payment penalties beginning in 2015. The document provides an overview of each program's objectives, measures, and reporting options to help physicians incorporate quality reporting into their practices.
The document discusses Michigan's Primary Care Transformation Demonstration Project. It provides information about 6 month and 12 month incentive disbursements, care manager utilization and patient registry status, HEDIS measure attainment, and care manager activity reporting requirements. It also discusses care manager disciplines, activity data collection, reporting options, and required data fields. Additional topics include learning activity requirements, education programs, webinars, Medicare Advantage quality measures and bonuses, risk adjustment importance, and new Medicare preventive services.
PQRI is the first Medicare program which will directly influence physicians towards value based purchasing (VBP). Value based purchasing is a key mechanism for Medicare to transform itself from being a passive payer to an active purchaser of healthcare by linking payment more directly to performance.
Currently, Medicare Physician Fee Schedule is based on quantity and resources consumed. Soon, this will no longer be the case. Over the next several years, fees will be increasing based on quality and value.
Inside ABC’s of PQRI:
Learning the Basics of PQRI
The Big Picture: Value-Based Purchasing
Engaging a Team
Selecting Measures
Coding on Performance Measures
Collecting Payment and Performance Report
Practice Exercise – Sample Case
Validation
Next Steps by Physicians
This strategic plan from Access HealthColumbus outlines its goals for 2013-2015 to improve patient-centered primary care in the local community. The plan's key objectives are to: 1) spread patient-centered medical homes, 2) spread primary care quality reporting, 3) spread provider-based patient engagement, and 4) spread value-based purchasing. Access HealthColumbus will serve as a catalyst and coordinator for collaborative projects with local healthcare organizations to achieve better care, better health, and better value for residents. The organization will focus on improving access to and coordination of primary care, especially for vulnerable populations.
This document contains guidelines for the Patient-Centered Medical Home (PCMH) and PCMH-Neighbor programs run by Blue Cross Blue Shield of Michigan (BCBSM). It outlines 14 domains of function that practices must meet capabilities for, such as patient registries, performance reporting, care management, and coordination of care. The document provides details on the required capabilities within each domain, interpretive guidelines, and requirements for verification site visits. It also addresses how specialists can partner with primary care practices through the PCMH-Neighbor program to better coordinate care for shared patients.
This document provides information about payment policies and billing guidelines for primary care transformation services through Michigan's Primary Care Transformation Demonstration Project. It discusses payment rates and codes for services like care management visits, group visits, and telephone consultations. Requirements are outlined for care management teams, eligible patients, documentation, and billing. Updates are provided from Blue Cross Blue Shield of Michigan and Blue Care Network on their payment policies and requirements.
This document discusses Michigan's Primary Care Transformation Demonstration Project. It outlines the agenda for webinar #10, including discussions on Medicaid and Medicare payments, care managers, project committees and metrics. It then provides details on performance metrics and incentives, care manager roles, clinical quality measures, and expectations for participating medical organizations. The webinar aims to update practices on the project and support development of patient-centered medical home capabilities.
MAFP Quality Reporting for Cash-CMS Incentives and Your Bottom Linelearfieldinteraction
This document discusses quality reporting incentives from CMS and their impact on physician practices. It outlines the requirements and incentives for three separate CMS programs - Meaningful Use, PQRS, and e-Prescribing. Participation in these programs can provide incentives, but failure to participate may result in payment penalties beginning in 2015. The document provides an overview of each program's objectives, measures, and reporting options to help physicians incorporate quality reporting into their practices.
The document discusses Michigan's Primary Care Transformation Demonstration Project. It provides information about 6 month and 12 month incentive disbursements, care manager utilization and patient registry status, HEDIS measure attainment, and care manager activity reporting requirements. It also discusses care manager disciplines, activity data collection, reporting options, and required data fields. Additional topics include learning activity requirements, education programs, webinars, Medicare Advantage quality measures and bonuses, risk adjustment importance, and new Medicare preventive services.
PQRI is the first Medicare program which will directly influence physicians towards value based purchasing (VBP). Value based purchasing is a key mechanism for Medicare to transform itself from being a passive payer to an active purchaser of healthcare by linking payment more directly to performance.
Currently, Medicare Physician Fee Schedule is based on quantity and resources consumed. Soon, this will no longer be the case. Over the next several years, fees will be increasing based on quality and value.
Inside ABC’s of PQRI:
Learning the Basics of PQRI
The Big Picture: Value-Based Purchasing
Engaging a Team
Selecting Measures
Coding on Performance Measures
Collecting Payment and Performance Report
Practice Exercise – Sample Case
Validation
Next Steps by Physicians
This strategic plan from Access HealthColumbus outlines its goals for 2013-2015 to improve patient-centered primary care in the local community. The plan's key objectives are to: 1) spread patient-centered medical homes, 2) spread primary care quality reporting, 3) spread provider-based patient engagement, and 4) spread value-based purchasing. Access HealthColumbus will serve as a catalyst and coordinator for collaborative projects with local healthcare organizations to achieve better care, better health, and better value for residents. The organization will focus on improving access to and coordination of primary care, especially for vulnerable populations.
This document contains guidelines for the Patient-Centered Medical Home (PCMH) and PCMH-Neighbor programs run by Blue Cross Blue Shield of Michigan (BCBSM). It outlines 14 domains of function that practices must meet capabilities for, such as patient registries, performance reporting, care management, and coordination of care. The document provides details on the required capabilities within each domain, interpretive guidelines, and requirements for verification site visits. It also addresses how specialists can partner with primary care practices through the PCMH-Neighbor program to better coordinate care for shared patients.
The document summarizes key points from a webinar about measuring success for the Health Care Innovation Challenge. It discusses measuring impact on better care, better health, and lower costs through improvement. Applicants are expected to select measures in these areas and demonstrate their ability to collect and analyze data to continuously evaluate performance. Operational performance should also be monitored through measurable goals and rapid cycle improvement. Applicants must provide a detailed operational plan to start improving care within 6 months of funding.
1. Community Care Teams and the Patient-Centered Medical Home (PCMH) model can be enhanced by including mental health and substance use services and care coordination to create a Person-Centered Healthcare Home (PCHH).
2. Community Care of North Carolina uses Community Care Networks (CCNs) that are public-private partnerships providing coordinated care through medical homes. Preliminary results show improved care for patients with chronic conditions and cost savings.
3. CCNs employ care managers who work with medical homes to coordinate care for high-risk patients through activities like patient education and addressing barriers to care.
Payment reform in the NHS is moving in several directions:
1) Expanding Payment by Results (PbR) to new areas like year of care payments and increasing its focus on quality, outcomes, and value.
2) Introducing new payment systems that incentivize quality, integration, and efficiency through mechanisms like best practice tariffs, the quality premium, and bundling payments.
3) Using payment reform as one part of broader reforms across health and social care to encourage integration, patient responsiveness, and improvements in outcomes.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
This document discusses preparing for quality reporting programs in 2013 under CMS, including the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier. It identifies 2013 PQRS reporting options like claims, registry, EHR, and administrative claims. It provides examples of successful reporting strategies for different practice sizes and specialties. The document emphasizes starting to report now to avoid penalties in future years.
The document provides an overview of the REACHOUT Bangladesh project which aimed to strengthen the capacity of close-to-community health providers through improving the referral system for Menstrual Regulation services. The summary is:
The REACHOUT Bangladesh project worked with implementing partners over multiple phases from 2013-2018 to improve the referral system and capacity of community health workers in Bangladesh. Through training, supportive supervision, and use of referral cards, the project aimed to enhance the skills of formal and informal providers in counseling and referring clients for Menstrual Regulation services. Research found the interventions improved provider motivation and referral practices over time. The project also focused on sustainability through embedding activities in partner organizations and building individual and institutional research capacity.
The Center for Medicare & Medicaid Services (CMS) recently announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes a new Medicare Advantage Gain Sharing program offered by Blue Cross Blue Shield of Michigan and Blue Care Network. It provides incentives for providers to improve performance in documentation and coding, utilization, costs, and quality measures. Providers can earn a share of financial gains if they meet education and performance criteria, such as attending training, closing diagnosis code gaps, and improving quality scores and readmission rates. The program compares potential earnings to an alternative diagnosis closure incentive program, paying providers the higher of the two amounts. It includes examples of how earnings are calculated based on members' risk scores and expenses.
February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Patient satisfaction & quality in health care (13.3.2017) dr.nyunt nyunt waiMmedsc Hahm
This document discusses patient satisfaction and quality in healthcare. It defines patient satisfaction as the degree to which patients regard healthcare services as useful, effective or beneficial. Patient satisfaction is important for public accountability and quality improvement at both the system and individual provider levels. The document outlines factors that influence patient satisfaction, including the quality and competency of providers, effectiveness and appropriateness of care, and interpersonal relationships. It also discusses the rights of patients and needs of providers in a client-centered healthcare model.
The document provides an overview of the NCQA PCMH 2011 standards and guidelines, outlining the six standards, key elements and factors, requirements around must pass elements and meaningful use, and the process for practices to complete a self-assessment and apply for recognition. It also discusses the benefits of achieving PCMH recognition and the multiple efforts supporting primary care practices through the transformation process.
The document summarizes key points from a PCP cluster meeting held on November 13, 2013 in Monroe, Michigan. The meeting focused on several topics: Medicare correct coding initiative, Choosing Wisely campaign, advance care planning, patient-centered medical home designations, organized systems of care, and risk adjustment. The risk adjustment portion provided details on CMS risk scoring, hierarchical condition categories, documentation requirements, and a case study example. It also discussed the Medicare Advantage STAR bonus program and its quality measures. Finally, the document covered advance care planning and POLST (Physician Orders for Life-Sustaining Treatment) forms.
This document provides updates on quarterly reports that must be submitted to Christine and ensure accuracy. It discusses that MiPCT requested MNO attestation of using the registry, having a quality improvement process, and reviewing data. Finally, it addresses education requirements of three 4-hour sessions on CPT and ICD-9 use, and notes that care management numbers have decreased but the care team remains. An extension of MiPCT is unknown and status quo for now.
The document discusses financial reporting requirements for organizations participating in the Michigan Primary Care Transformation Demonstration Project. It provides information on templates for reporting revenue, expenses, and membership for care coordination and practice transformation activities. It outlines reporting deadlines and requirements for documenting expenses. Guidelines are provided for reporting care management activities, retaining excess Medicaid funds, and incentivizing practices.
This document outlines details from a webinar on the Michigan Primary Care Transformation Demonstration Project that took place on October 23, 2013. It lists the practices in attendance and their scheduled dates to present their best practices. It also discusses funding, learning requirements, practice visits, the Choosing Wisely campaign, and the State Innovation Model initiative. The webinar covered key details about the project for the participating primary care practices.
This document outlines a webinar for the Michigan Primary Care Transformation Demonstration Project. It lists the practices in attendance at the webinar and their scheduled dates for best practice visits. It also details the learning requirements for care managers and practice units in 2014. Finally, it notes which practices attended a learning event in 2013 and which were absent.
This document summarizes a webinar for the Michigan Primary Care Transformation Demonstration Project. It recognizes several practices that have received URAC accreditation or will be undergoing upcoming audits. It discusses care manager training programs and liability insurance coverage for care managers. It also outlines various pilot programs and initiatives around topics like shared medical visits, billing and coding seminars, metrics tracking, and increasing physician engagement in transformation efforts.
This document outlines a webinar for the Michigan Primary Care Transformation Demonstration Project. It lists the practices in attendance at the webinar and their scheduled dates for best practice showcases. It also details the learning requirements for care managers and practice units in 2014, including required hours and acceptable training activities. Finally, it lists the practices that participated in a learning event in 2013 and those that were absent.
This document summarizes information from a presentation about Michigan's Primary Care Transformation Demonstration Project. It discusses care management training requirements, provider requirements including having a qualified care management team, patient eligibility criteria for BCBSM and Medicaid, billing codes and documentation guidelines, metrics that will be measured, and the process for performance-based incentive payments.
Medical Billing for Primary Care Exception.pptxpatriciaava1998
In this article, let's understand the actual meaning of Primary Care Exception and the Attestation Checklist and the Billing and Coding of Outpatient E/M Services.
Fundamentals of Bundles for Joint Replacement – Creating the Competitive EdgeWellbe
Medicare is expected to issue the final rule for the Comprehensive Care for Joint Replacement (CJR) initiative soon. As proposed, hospitals in chosen MSAs must be ready to take on this new challenge by January 1, 2016.
The Connecticut Joint Replacement Institute (CJRI) at Saint Francis Hospital has performed more than 20,000 procedures since opening in 2007. CJRI has been on the forefront of bundled payments for joint replacements since implementing their first bundle agreement in 2010. CJRI will share the essential elements to developing a bundle program and the challenges of evolving towards a value-driven, risk bearing model in today’s healthcare environment.
Attendee Takeaways:
– Learn the essential ingredients to develop a successful bundle payment program
– Understand the fundamentals of value-based healthcare
– Learn how to create sustainable bundled payments and maintain a competitive edge in the marketplace
About The Speaker:
Maureen Geary is the Program Director at the Connecticut Joint Replacement Institute in Hartford, Connecticut. Maureen been involved with bundle payments since 2009. CJRI signed their first commercial contract in 2010. She leads strategic initiatives and new product development for the company. Maureen also provides consultative services for orthopedic organizations seeking to develop a bundled product or expand their service line.
This document summarizes a webinar for the Michigan Primary Care Transformation Demonstration Project. It discusses the definition of the project and statewide rollout, participation and funding updates, care management training requirements, and next steps practices need to take to meet metrics for care managers and quality measures in the coming months. The webinar focused on establishing care management teams, training requirements, and planning activities to support self-management for patients with chronic conditions.
The document summarizes key points from a webinar about measuring success for the Health Care Innovation Challenge. It discusses measuring impact on better care, better health, and lower costs through improvement. Applicants are expected to select measures in these areas and demonstrate their ability to collect and analyze data to continuously evaluate performance. Operational performance should also be monitored through measurable goals and rapid cycle improvement. Applicants must provide a detailed operational plan to start improving care within 6 months of funding.
1. Community Care Teams and the Patient-Centered Medical Home (PCMH) model can be enhanced by including mental health and substance use services and care coordination to create a Person-Centered Healthcare Home (PCHH).
2. Community Care of North Carolina uses Community Care Networks (CCNs) that are public-private partnerships providing coordinated care through medical homes. Preliminary results show improved care for patients with chronic conditions and cost savings.
3. CCNs employ care managers who work with medical homes to coordinate care for high-risk patients through activities like patient education and addressing barriers to care.
Payment reform in the NHS is moving in several directions:
1) Expanding Payment by Results (PbR) to new areas like year of care payments and increasing its focus on quality, outcomes, and value.
2) Introducing new payment systems that incentivize quality, integration, and efficiency through mechanisms like best practice tariffs, the quality premium, and bundling payments.
3) Using payment reform as one part of broader reforms across health and social care to encourage integration, patient responsiveness, and improvements in outcomes.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
This document discusses preparing for quality reporting programs in 2013 under CMS, including the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier. It identifies 2013 PQRS reporting options like claims, registry, EHR, and administrative claims. It provides examples of successful reporting strategies for different practice sizes and specialties. The document emphasizes starting to report now to avoid penalties in future years.
The document provides an overview of the REACHOUT Bangladesh project which aimed to strengthen the capacity of close-to-community health providers through improving the referral system for Menstrual Regulation services. The summary is:
The REACHOUT Bangladesh project worked with implementing partners over multiple phases from 2013-2018 to improve the referral system and capacity of community health workers in Bangladesh. Through training, supportive supervision, and use of referral cards, the project aimed to enhance the skills of formal and informal providers in counseling and referring clients for Menstrual Regulation services. Research found the interventions improved provider motivation and referral practices over time. The project also focused on sustainability through embedding activities in partner organizations and building individual and institutional research capacity.
The Center for Medicare & Medicaid Services (CMS) recently announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.
This webinar will allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.
More at: http://innovations.cms.gov/resources/CCTP-RdcReadmiss.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes a new Medicare Advantage Gain Sharing program offered by Blue Cross Blue Shield of Michigan and Blue Care Network. It provides incentives for providers to improve performance in documentation and coding, utilization, costs, and quality measures. Providers can earn a share of financial gains if they meet education and performance criteria, such as attending training, closing diagnosis code gaps, and improving quality scores and readmission rates. The program compares potential earnings to an alternative diagnosis closure incentive program, paying providers the higher of the two amounts. It includes examples of how earnings are calculated based on members' risk scores and expenses.
February 9, 2012
These slides are designed for Post-Acute Care (PAC) providers seeking additional information about how Model 3 works and a better understanding of the opportunities for PAC providers within the Bundled Payment for Care Improvement (BPCI) initiative to achieve better care, better health and lower costs for their patients through care redesign.
More at: http://innovations.cms.gov/resources/Bundled-Payments-Model-3-Deep-Dive.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Patient satisfaction & quality in health care (13.3.2017) dr.nyunt nyunt waiMmedsc Hahm
This document discusses patient satisfaction and quality in healthcare. It defines patient satisfaction as the degree to which patients regard healthcare services as useful, effective or beneficial. Patient satisfaction is important for public accountability and quality improvement at both the system and individual provider levels. The document outlines factors that influence patient satisfaction, including the quality and competency of providers, effectiveness and appropriateness of care, and interpersonal relationships. It also discusses the rights of patients and needs of providers in a client-centered healthcare model.
The document provides an overview of the NCQA PCMH 2011 standards and guidelines, outlining the six standards, key elements and factors, requirements around must pass elements and meaningful use, and the process for practices to complete a self-assessment and apply for recognition. It also discusses the benefits of achieving PCMH recognition and the multiple efforts supporting primary care practices through the transformation process.
The document summarizes key points from a PCP cluster meeting held on November 13, 2013 in Monroe, Michigan. The meeting focused on several topics: Medicare correct coding initiative, Choosing Wisely campaign, advance care planning, patient-centered medical home designations, organized systems of care, and risk adjustment. The risk adjustment portion provided details on CMS risk scoring, hierarchical condition categories, documentation requirements, and a case study example. It also discussed the Medicare Advantage STAR bonus program and its quality measures. Finally, the document covered advance care planning and POLST (Physician Orders for Life-Sustaining Treatment) forms.
This document provides updates on quarterly reports that must be submitted to Christine and ensure accuracy. It discusses that MiPCT requested MNO attestation of using the registry, having a quality improvement process, and reviewing data. Finally, it addresses education requirements of three 4-hour sessions on CPT and ICD-9 use, and notes that care management numbers have decreased but the care team remains. An extension of MiPCT is unknown and status quo for now.
The document discusses financial reporting requirements for organizations participating in the Michigan Primary Care Transformation Demonstration Project. It provides information on templates for reporting revenue, expenses, and membership for care coordination and practice transformation activities. It outlines reporting deadlines and requirements for documenting expenses. Guidelines are provided for reporting care management activities, retaining excess Medicaid funds, and incentivizing practices.
This document outlines details from a webinar on the Michigan Primary Care Transformation Demonstration Project that took place on October 23, 2013. It lists the practices in attendance and their scheduled dates to present their best practices. It also discusses funding, learning requirements, practice visits, the Choosing Wisely campaign, and the State Innovation Model initiative. The webinar covered key details about the project for the participating primary care practices.
This document outlines a webinar for the Michigan Primary Care Transformation Demonstration Project. It lists the practices in attendance at the webinar and their scheduled dates for best practice visits. It also details the learning requirements for care managers and practice units in 2014. Finally, it notes which practices attended a learning event in 2013 and which were absent.
This document summarizes a webinar for the Michigan Primary Care Transformation Demonstration Project. It recognizes several practices that have received URAC accreditation or will be undergoing upcoming audits. It discusses care manager training programs and liability insurance coverage for care managers. It also outlines various pilot programs and initiatives around topics like shared medical visits, billing and coding seminars, metrics tracking, and increasing physician engagement in transformation efforts.
This document outlines a webinar for the Michigan Primary Care Transformation Demonstration Project. It lists the practices in attendance at the webinar and their scheduled dates for best practice showcases. It also details the learning requirements for care managers and practice units in 2014, including required hours and acceptable training activities. Finally, it lists the practices that participated in a learning event in 2013 and those that were absent.
This document summarizes information from a presentation about Michigan's Primary Care Transformation Demonstration Project. It discusses care management training requirements, provider requirements including having a qualified care management team, patient eligibility criteria for BCBSM and Medicaid, billing codes and documentation guidelines, metrics that will be measured, and the process for performance-based incentive payments.
Medical Billing for Primary Care Exception.pptxpatriciaava1998
In this article, let's understand the actual meaning of Primary Care Exception and the Attestation Checklist and the Billing and Coding of Outpatient E/M Services.
Fundamentals of Bundles for Joint Replacement – Creating the Competitive EdgeWellbe
Medicare is expected to issue the final rule for the Comprehensive Care for Joint Replacement (CJR) initiative soon. As proposed, hospitals in chosen MSAs must be ready to take on this new challenge by January 1, 2016.
The Connecticut Joint Replacement Institute (CJRI) at Saint Francis Hospital has performed more than 20,000 procedures since opening in 2007. CJRI has been on the forefront of bundled payments for joint replacements since implementing their first bundle agreement in 2010. CJRI will share the essential elements to developing a bundle program and the challenges of evolving towards a value-driven, risk bearing model in today’s healthcare environment.
Attendee Takeaways:
– Learn the essential ingredients to develop a successful bundle payment program
– Understand the fundamentals of value-based healthcare
– Learn how to create sustainable bundled payments and maintain a competitive edge in the marketplace
About The Speaker:
Maureen Geary is the Program Director at the Connecticut Joint Replacement Institute in Hartford, Connecticut. Maureen been involved with bundle payments since 2009. CJRI signed their first commercial contract in 2010. She leads strategic initiatives and new product development for the company. Maureen also provides consultative services for orthopedic organizations seeking to develop a bundled product or expand their service line.
This document summarizes a webinar for the Michigan Primary Care Transformation Demonstration Project. It discusses the definition of the project and statewide rollout, participation and funding updates, care management training requirements, and next steps practices need to take to meet metrics for care managers and quality measures in the coming months. The webinar focused on establishing care management teams, training requirements, and planning activities to support self-management for patients with chronic conditions.
This document outlines the agenda and details of the Michigan Primary Care Transformation Demonstration Project Webinar #3. The webinar will cover statewide rollout, participation requirements, registry requirements, pay for performance, financial accountability, and care management training. It provides information on the launch meeting, participation expectations, educational events, care manager training schedules and assignments, care team composition, and pay for performance metrics and reporting.
How to Achieve a PCMH Certification - Small Practice - Practice-centered medi...Donte Murphy
This is a PowerPoint presentation from Dr. Khan, Medical Director, MedPeds Medical Clinic. He has a small practice and is a certified PCMH. In this presentation he shares his strategy that led to his success. This is a powerful presentation for practices of all sizes, whether large or small. For more information, feel free to email us at: marketing@amazingcharts.com.
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
The document discusses the development of correctional nursing as a specialty practice area. It outlines the history of advancing correctional nursing through establishing certification and developing a certification exam. Key points include the emergence of specialty nursing in the late 1970s/early 1980s in response to complex patient needs, the establishment of the Certified Correctional Health Professional-Nurse certification and associated exam, and future directions for the specialty such as integrating nursing standards, establishing centers of excellence, and conducting nursing research specific to the correctional setting.
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
The Medicare Care Choices Model aims to expand access to concurrent palliative and curative care for Medicare beneficiaries with serious illnesses. It will test allowing participating hospices to provide supplemental palliative care services to eligible beneficiaries, while receiving curative treatment, in return for a $400 per beneficiary per month fee. Hospices must be Medicare-certified and able to coordinate care. Eligible beneficiaries have advanced cancers, lung disease, heart failure or HIV/AIDS. The model seeks to improve pain and symptom management through 24/7 access to hospice professionals and care coordination over three years. CMS implementation contractors will provide technical support to participating hospices.
CMS hosted an open door forum (ODF) call on Wednesday, April 16, 2014 to allow providers, beneficiary advocacy groups, and other interested parties to learn more about the Medicare Care Choices Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Diabetes Prevention Program (MDPP) Model Expansion Medicare Learning Network (MLN) Call was held from 1:30 p.m. – 3:00 p.m. EST on November 30, 2016. During this call, CMS experts provided a high-level overview of the finalized policies in the CY 2017 Medicare Physician Fee Schedule (PFS) final rule (the CY 2017 Medicare PFS final rule includes the expansion of the MDPP Model beginning January 1, 2018), reviewed the steps necessary for enrollment into Medicare as an MDDPP supplier, and answered some of the audiences most pressing questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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MACRA consolidated several existing Medicare quality programs and introduced new payment models. It established two tracks for physician payment and quality programs starting in 2017 - MIPS and Advanced APMs. MIPS consolidated existing programs into four categories and allows physicians to gradually increase their participation over multiple years. Advanced APMs provide incentives for participation in alternative payment models and include models like Accountable Care Organizations. MACRA aims to reform Medicare payments to physicians and transition to value-based models.
COVID-19 has changed the landscape of long-term care for the foreseeable future for everyone from ownership to admissions. In this webinar, we will help you understand the changing dynamic with managed care and how to properly manage your cash flow. Hear from industry experts on their best practices and tips for financial management for long-term care professionals.
The document discusses the transition to value-based care models and accountable care organizations (ACOs). It outlines five core competencies needed for early success in an ACO program like the Medicare Shared Savings Program (MSSP): 1) physician-centered governance, 2) collection and reporting of quality metrics, 3) data analysis and spend identification, 4) developing a post-acute quality provider network, and 5) population management strategies. It provides examples from Methodist Health System's experience in an MSSP ACO.
Onsite Care: Can This Strategy Change Your Health Care Game?HNI Risk Services
Onsite care programs are rapidly gaining popularity, both as a mechanism to control costs and to increase the value of benefits offered to employees. Employees love onsite clinics for the convenient access to care they provide — and employers are eager to realize cost savings, enhance worker productivity, and tout the value of the offering to attract and retain talent.
This document summarizes a webinar for primary care physicians and practice teams from Medical Network One. It recognizes physicians who received Patient-Centered Medical Home designations from BCBSM. It outlines ongoing activities like care teams, collaborative projects, and enterprise-wide initiatives to support practices. These include the CMS MiPCT demonstration project, diabetes and behavioral health programs, care manager training, and organized systems of care. Attendees are asked for input on communication, collaboration, and future initiatives.
This document advertises a study seeking 20 adults aged 35 or older who are at risk of or living with diabetes, have not had formal diabetes education in the past year, regularly use the internet, and can read and speak English, to complete two 20-minute online surveys for $40 total to help improve a diabetes website, with recruitment occurring through November 15, 2014.
This document provides information on various programs and services available for breast and cervical cancer screening, family planning, pregnancy and new mother support, pediatric care, and dental care in Macomb and Oakland counties in Michigan. It lists contact information, eligibility requirements, and services offered for programs like BCCCP, WIC, Medicaid family planning services, food pantries, counseling services, and low-cost dental clinics.
The document describes strategies for developing effective healthcare teams. It discusses establishing care teams with interdisciplinary members and providing training. Key elements of team-based care include protocol-driven processes, care management services, managing care transitions, and engaging patients and families. The document also outlines metrics for measuring utilization, clinical quality, and care processes and explains that implementing a bundle of improvement changes through an interdisciplinary team approach leads to better outcomes.
This document outlines the agenda for a MiPCT Demonstration Project meeting, including: introducing new practice team members, comparing G code billing results between practices, discussing care managers and metrics for 2014. It reviews utilization, clinical quality, and process measures that will be assessed. Learning requirements are outlined for care managers and practice teams, including ICD-10 workshops and a learning collaborative. Participating practice teams are listed and an open discussion is invited.
This document summarizes a focus meeting for PCPs that covered several topics: Medicare risk adjustment, risk scoring, and quality star ratings; the Choosing Wisely campaign; advance care planning; and patient-centered medical homes. It provided details on CMS risk adjustment models, proper medical record documentation for risk adjustment, and ways accurate coding can improve reimbursement and lower member premiums. It also reviewed the STAR bonus program metrics and preventive services. Finally, it discussed introducing advance care planning conversations, documenting patient preferences, and applying advance directives when needed.
This document summarizes a PCP focus meeting that covered several topics: Medicare correct coding initiative, Choosing Wisely campaign, advance care planning, patient-centered medical home designations, organized systems of care, optimizing risk adjustment and stars ratings, and advance directives. It provides details on CMS risk adjustment models, required medical record documentation, acceptable provider types and signatures, case studies, and steps for successful advance care planning.
Behavioral Health Specialist Meeting: Keeping You in the Loopmednetone
The document summarizes key points from a meeting between Medical Network One and behavioral health specialists. It introduced Medical Network One and described its history of collaborating with BCBSM on initiatives like the Physician Group Incentive Program (PGIP), Patient-Centered Medical Home (PCMH), and Organized Systems of Care (OSC). It discussed how collaboration between Medical Network One and behavioral health specialists might work, including developing shared goals and responsibilities. The document also provided an overview of the PCMH, PCMH-Neighborhood, and OSC models, and explained how performance is measured using standards like HEDIS.
This document outlines guidelines for collaboration between primary care and specialty care providers to improve patient care. It defines key terms like patient-centered medical home and discusses different types of care transitions including pre-consultation, formal consultation, complete transfer of care, and co-management. The guidelines establish mutual agreements around maintaining accurate records, safe transfers of care, and adopting a referral system. It provides templates for primary care and specialty care expectations in areas like maintaining records, ordering tests, informing patients, and timely communication. The overall goal is to enhance communication and collaboration between providers through coordinated, patient-centered care.
The document advertises the R-Team healthy lifestyle program for kids and teens. The 10-session program teaches healthy eating, exercise, self-esteem and goal setting. Each child receives an individual assessment before starting group sessions. Parents must attend all sessions with their child. Contact and registration information is provided for programs in Madison Heights, Woodhaven and Rochester, Michigan between March 2015 and November 2015.
This document provides information about the Michigan Primary Care Transformation Demonstration Project webinar that took place on September 25, 2013. It lists the practices that attended the webinar and announces an upcoming learning event on September 28th to provide updates to practice teams on new billing codes, advance care planning, and quality improvement processes. It then outlines the schedule for best practice showcases at different practices between September 2013 and April 2014. The document concludes by defining key terms related to the Multi-payer Advanced Primary Care Practice Demonstration, including the purpose and goals of evaluating the demonstration and defining care management.
This document summarizes a webinar for the Michigan Primary Care Transformation Demonstration Project. It lists the attendees of the webinar and recognizes practices that have achieved URAC accreditation or provided appreciation. It outlines quality metrics and goals for care managers, such as engaging patients in care management. It also announces upcoming training events for care managers and practices in July and a challenge to enroll new patients. Time is allotted at the end for open discussion.
The document describes several healthcare organizations' Performance Recognition Programs (PRP) for 2013. It outlines changes made to the programs, including increasing budgets, eliminating pay-as-you-go components, and scoring providers individually on quality measures. Providers can earn payments by meeting quality goals or improving scores by a certain percentage. The programs include measures related to preventative screenings, disease management, and controlling conditions like diabetes and cardiovascular disease. Bonus payments are available for measures like adult BMI tracking and annual medication monitoring.
This referral form provides patient and physician information for referral to Medical Nutrition Therapy and Diabetes Self Management Education. It includes the patient's name, date of birth, contact information, insurance information, and health details like blood pressure, height, and weight. The form indicates a need for either initial or follow-up Medical Nutrition Therapy, and lists possible reasons for referral to Diabetes Self Management Training. Relevant medical details and lab results are requested to better assess the patient's needs. The referring physician's signature and contact information is included.
This document provides information about care coordination best practices and a Michigan primary care transformation demonstration project. It discusses that Hampton Medical Center received URAC accreditation. It also notes that federal spending reductions went into effect in April 2013. The document outlines metrics for year three, pay for performance details from year end 2012, and upcoming sharing activities and team learning events for practices participating in the demonstration project. It provides refreshers on what care coordination and effective care coordination entail, and discusses promising care coordination interventions and what distinguishes successful models.
The document discusses metrics for evaluating Michigan's Primary Care Transformation Demonstration Project in its second and third years. In year two, the project will measure optimization of care management, quality metrics, and avoidance of high-cost care. Data will come from claims, practice reports, and clinical registry data. Metrics include hiring and training of care managers, notifications of admissions/discharges, and patient registry functionality for chronic illness tracking. The goal for year three is achieving improved quality, experience, and cost through the "Triple Aim."
The document provides information about Medicare coverage of the Annual Wellness Visit (AWV) and Personalized Prevention Plan Services (PPPS). It details the minimum elements that must be included in the initial AWV, such as acquiring a health risk assessment and medical history, conducting an examination, and developing a screening schedule and prevention plan. It also outlines the elements included in subsequent annual visits, including updating the beneficiary's health history and risk factors. The purpose is to provide personalized health advice and referrals to help beneficiaries stay healthy.
Over 23 million Americans have diabetes, which can lead to serious health complications like heart disease, stroke, kidney disease, and blindness. Medical Network One is a physician organization that develops wellness programs and active care plans for patients with chronic conditions like diabetes through education on managing blood sugar levels, nutrition, physical activity, and medications. Their Diabetes Self-Management Education program teaches individuals how to adjust their lifestyle and maintain control of their diabetes through group and individual sessions with doctors, nurses, dietitians and other experts.
The document outlines the steps a primary care physician should take to enroll diabetes patients in a self-management education program run by MIHE. The physician completes a referral form with patient information and labs, faxes it to MIHE, who then contacts the patient to set up an assessment. After assessment, the patient is enrolled in the program. Physicians are notified upon completion or if a patient declines or cannot be reached.
This document contains a request form for diabetes self-management education (DSME) and medical nutritional therapy (MNT). It requests patient information like name, DOB, address, diagnosis, and medications. It also requests the type of DSME being ordered like initial training, follow up training, or special needs. For MNT, it requests initial sessions, annual follow ups, or additional services. Clinical information is also requested like complications, comorbidities, and recent lab results. The form is to be signed and dated by the referring provider and includes contact information.
This document is a pediatric medical clearance form for a weight management program. It requests information about the patient such as name, date of birth, insurance, and contact details. It requires a physical exam from the last 12 months including height, weight, blood pressure, and waist circumference. It lists required and optional lab tests from the last 12 months. It asks if the patient has been evaluated by other specialists for weight-related issues. The referring physician must sign off, clearing the patient to participate in exercise sessions and group activities in the weight management program.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
5. MiPCT Meetings
March 20, 2012 (9am-12noon or 5pm-8pm)
March 28, 2012 (9am-3pm)
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6. Care Manager Training
Moderate Care Manager
• Self Management Training
• Completed by June 30, 2012
• Approved learning organization that provides
Certificate or CEU
Complex Care Manager
• Geisinger Model Training
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7. Care Manager Training
Classroom
25 hour curriculum
• Pre-work
• Care Manager Project
Options
• Group Orientation: March 27 or 29 (9am – 12noon)
• April 7, 14, 21, 28
• May 5, 12, 19, June 2
• April 3, 10, 24, May 1, 8, 15, 22, 29, June 5, 12, 19
• April 5, 12, 19, 26, May 3, 10, 17, 24, 31, June 7, 14
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8. Care Manager Training
Virtual
25 hour curriculum
• Pre-work
• Care Manager Project
Options
• Group Orientation: March 27, 28 or 29 (9am – 12noon)
• Web based interactive
•April 2, 9, 16, 23, 30, May 7, 14, 21, June 4, 11
•April 4, 11, 18, 25, May 2, 9, 16, 23, 30, June 6
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9. Care Manager
Final Assessment
Two hour final assessment
June 7, 8, 9, 10 or 17 (9am-10am or 6pm-8pm)
Morning or evening meeting
Enrollment dependent
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10. Care Manager Assignment
Care Managers available
• Dawn Carroll**
• Dawn D’Allesandro
• Margaret Kucinski**
• Deb Kobayashi
• Ilene Latasiewicz
• Kim Roberts (Pediatrics Only)
• Angie Siegmon
• Deb Slocum
• Pam Vaccarelli
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11. PDCM Payment Policy
7 codes for services performed by qualified non-
physician practitioners
Payable to approved providers only
BCBSM will pay the lesser of provider charges or
BCBSM’s maximum fee
•PCMH-designation status uplifts of 10% or 20%
•CNPs or PAs paid at 85%
No cost share imposed on members EXCEPT
members with Qualified High Deductible Health
Plans with a Health Savings Account
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13. General Conditions of Payment
For billed services to be payable, the following
conditions apply:
• The patient must be eligible for PDCM coverage
• The services must be delivered and billed under the
auspices of a practice or practice-affiliated PO
approved by BCBSM for PDCM reimbursement
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14. General Conditions of Payment
For billed services to be payable, the following
conditions apply:
•Based on patient need
•Ordered by a physician, PA or CNP within the
approved practice
•Performed by the appropriate qualified, non-
physician health care professional employed or
contracted with the approved practice or PO
• Billed in accordance with BCBSM billing guidelines
Non-approved providers billing for PDCM services
will be subject to audit and recoveries
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15. Patient Eligibility
The patient must have active BCBSM coverage
that includes the BlueHealthConnection® Program
This includes:
• BCBSM underwritten business
• ASC (self-funded) groups that elect to participate
• Medicare Advantage patients (further detail
forthcoming)
Services billed for non-eligible members will be rejected with provider liability.
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16. Patient Eligibility
Checking eligibility:
• Eligible members with PDCM coverage will be
flagged on the monthly patient list
• Providers should also check normal eligibility
channels (e.g., WebDENIS, CAREN IVR) to confirm
BCBSM overall coverage eligibility
The patient must be an active participant in the
care plan
Services billed for non-eligible members will be rejected with provider liability.
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17. Patient Eligibility
The patient must be an active patient under the
care of a physician, PA or CNP in a PDCM-
approved practice and referred by that clinician
for PDCM services
• No diagnosis restrictions are applied
• Referral should be based on patient need
The patient must be an active participant in the
care plan
Services billed for non-eligible members will be rejected with provider liability.
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18. Provider Requirements: Care
Management Team
Individuals performing PDCM services must be
qualified non-physician practitioners employed by
practices or practice-affiliated POs approved for PDCM
payments
The team must consist of:
• A lead care manager who:
•Is an RN, licensed MSW, CNP or PA
•Has completed an MiPCT-accepted training program
• Other qualified allied health professiona
•LPN, CDE, RD, nutritionist, clinical pharmacist, respiratory therapist,
certified asthma educator, certified health educator specialist
(bachelor’s degree or higher), licensed professional counselor, licensed
mental health counselor, certified health educator specialist (bachelor’s
degree or higher), licensed professional counselor, licensed mental
health counselor
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19. Provider Requirements: Care
Management Team
Each qualified care team member must:
• Function within their defined scope of practice
• Work closely and collaboratively with the patient’s
clinical care team
• Work in concert with BCBSM care management nurses
as appropriate
Only lead care managers may perform the initial assessment services
(G9001)
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20. Provider Requirements: Billing
and Rendering Provider
Rendering Billing
Provider Provider
Practice-based Physician, CNP or PA within the Physician practice
PDCM-approved practice
Physician Organization-based PO-based billing entity
• PDCM services are only payable to practices or
POs approved for PDCM reimbursement.
•For 2012, MiPCT-participating providers only
• Two potential models
•Practice-based care management team
•Physician-organization-based care management
team
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21. Billing and Documentation:
General Guidelines
The following general billing guidelines apply to
PDCM services:
• Approved practices/POs only
• Professional claim
•7 procedure codes
•PDCM may be billed with other medical
services on the same claim
•PDCM may be billed on the same day as
other physician services
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22. Billing and Documentation:
General Guidelines
• No diagnostic restrictions
•All relevant diagnoses should be identified on
the claim
• No quantity limits (except G9001)
• No location restrictions
• Documentation demonstrating services were
necessary and delivered as reported
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23. Initiation of Care Management
(Comprehensive Assessment)
G9001 Coordinated Care Fee, Initial Rate (per case)
Payable only when performed by an RN, MSW, CNP or PA with approved level of care management
training (i.e., lead care manager)
One assessment per patient per year
Contacts must add up to at least 30 minutes of discussion
Assessment should include:
• Identification of all active diagnoses
• Assessment of treatment regimens, medications, risk factors, unmet needs, etc.
• Care plan creation (issues, outcome goals, and planned interventions)
Billed claims must include:
• Date of service (date patient is “enrolled” in care management)
• All active diagnoses identified in the assessment process
Record documentation must additionally include:
• Dates, duration, name/credentials of care manager performing the service
• Formal indication of patient engagement/enrollment
• Physician coordination and agreement
NOTE: More detailed requirements/expectations applicable to Medicare Advantage patients are
under development.
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24. Individual, Face-to-Face Visit
G9002 Coordinated Care Fee, Maintenance rate (per encounter)
Payable when performed by any qualified care management team member
No quantity limits
Encounters must:
• Be conducted in person
• Be a substantive, focused discussion pertinent to patient’s care plan
Claims reporting requirements:
• Each encounter should be billed on its own claim line
• All diagnoses relevant to the encounter should be reported
Record documentation must additionally include:
• Date, duration, name/credentials of team member performing the service
• Nature of discussion and pertinent details relevant to care plan (progress, changes, etc.)
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25. Group Education & Training Visit
98961 Education and training for patient self-management for 2-4 patients, 30 minutes
98962 Education and training for patient self-management for 5-8 patients, 30 minutes
Payable when performed by any qualified care management team member
No quantity limits
Each session must:
• Be conducted in person
• Have at least two, but no more than eight patients present
• Include some level of individualized interaction
Claims reporting requirements:
• Services should be separately billed for each individual patient
• Code selection depends upon total number of patient participants in the session
• Quantity depends upon length of session (reported in thirty minute increments)
• All diagnoses relevant to the encounter should be reported
Additional documentation requirements:
• Dates, duration, name/credentials of care manager performing the service
• Nature of content/objectives, number of patients present
• Any updated status on patient’s condition, needs, progress
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26. Telephone-based Services
98966 Telephone assessment and management, 5-10 minutes
98967 Telephone assessment and management, 11-20 minutes
98968 Telephone assessment and management, 21+ minutes
Payable when performed by any qualified care management team member
No more than one per date of service (if multiple calls are made on the same day, the times spent on
each call should be combined and reported as a single call)
Each encounter must:
• Be conducted by phone
• Be at least 5 minutes in duration
• Include a substantive, focused discussion pertinent to patient’s care plan
Claims reporting requirements
• Code selection depends upon duration of phone call
• All diagnoses relevant to the encounter should be reported
Additional documentation requirements:
• Dates, duration, name/credentials of care manager performing the call
• Nature of the discussion and pertinent details regarding updates on patient’s condition, needs,
progress
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