Following is a multipayer comparative grid that may be helpful to practices and POs. 2017 Michigan Commercial CPC+ Commercial Revenue Comparative Grid What Do I Attributed Care Alt to FFS or FFS Were 2017 Report? (By Patients Management Alternative Payments Reports Provided Payer) Fees to PO for Sharing with (See ) Practices? BCBSM Number of Report PDCM Report PGIP Y for VBR payments for – BCBSM Care (or VBR) the 1/1 to 11/30 2017 CPC+ Management G payments you receive for period patients and CPT Code BCBSM CPC+ members attributed Revenue for (this includes the PCMH to your CPC+ Members VBR, Cost VBR, Clinical practice Quality VBR, PDCM VBR and PCMH3 VBR) Priority Number of Report G and CPT Report the PMPM care N - But plans to do so for Health Priority Care management incentive fee 2018 reporting Health Management you are paid by Priority for CPC+ Code FFS attributed members patients Revenue for attributed Priority Health to your CPC+ members practice HealthSCOPE N/A N/A N/A N/A Benefits Other Related Information: Are There Special CPC+ Agreements I Need to Sign with Commercial Plans? If your practice had payment incentives and arrangements with BCBSM and Priority Health that existed prior to CPC+, these also apply to CPC+ and thus, no new or special CPC+ contract or agreement is necessary for the vast majority of CPC+ practices and would thus report “YES”, that you have a contractual agreement with each payer to receive CPC+ payments and other supports. Only practices without any type of payment incentive or arrangement with these payers would report to this question. This constitutes a very small number of practices. “no” (See p. 2 of the 2017 CPC Financial Reporting Guide). What Do I Report for HealthSCOPE Benefits for 2017? HealthSCOPE Benefits joined as a payer on 1/1/18 and hence, no CPC+ 2017 revenue was issued to practices.
Following is a multipayer comparative grid that may be helpful to practices and POs. 2017 Michigan Commercial CPC+ Commercial Revenue Comparative Grid What Do I Report? (By Payer) Attributed Patients Care Management Fees (See ) Alt to FFS or FFS Alternative Payments Were 2017 Reports Provided to PO for Sharing with Practices? BCBSM Number of BCBSM CPC+ patients attributed to your practice Report PDCM Care Management G and CPT Code Revenue for CPC+ Members Report PGIP (or VBR) payments you receive for BCBSM CPC+ members (this includes the PCMH VBR, Cost VBR, Clinical Quality VBR, PDCM VBR and PCMH3 VBR) Y – for VBR payments for the 1/1 to 11/30 2017 period Priority Health Number of Priority Health CPC+ patients attributed to your practice Report G and CPT Care Management Code FFS Revenue for Priority Health CPC+ members Report the PMPM care management incentive fee you are paid by Priority for attributed members N - But plans to do so for 2018 reporting HealthSCOPE Benefits N/A N/A N/A N/A Other Related Information: Are There Special CPC+ Agreements I Need to Sign with Commercial Plans? If your practice had payment incentives and arrangements with BCBSM and Priority Health that existed prior to CPC+, these also apply to CPC+ and thus, no new or special CPC+ contract or agreement is necessary for the vast majority of CPC+ practices and would thus report “YES”, that you have a contractual agreement with each payer to receive CPC+ payments and other supports. Only practices without any type of payment incentive or arrangement with these payers would report “no” to this question. This constitutes a very small number of practices. (See p. 2 of the 2017 CPC Financial Reporting Guide). What Do I Report for HealthSCOPE Benefits for 2017? HealthSCOPE Benefits joined as a payer on 1/1/18 and hence, no CPC+ 2017 revenue was issued to practices.
reporting-michigan-cpc-commercial-payer-revenue-to-cms-a-quick-guide1.docx