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Medicare Funds Flow Upfront Care Coordination ($4.50 PMPM) Retrospective Incentives ($3.00 PMPM) CMS UMHS (as a pass-through) POs/PHOs CMS Practices Upfront.

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Presentation on theme: "Medicare Funds Flow Upfront Care Coordination ($4.50 PMPM) Retrospective Incentives ($3.00 PMPM) CMS UMHS (as a pass-through) POs/PHOs CMS Practices Upfront."— Presentation transcript:

1 Medicare Funds Flow Upfront Care Coordination ($4.50 PMPM) Retrospective Incentives ($3.00 PMPM) CMS UMHS (as a pass-through) POs/PHOs CMS Practices Upfront Practice Transformation ($2.00 PMPM) Practices* *At least 80% of the incentives must be provided to practices by POs/PHOs. ** Not a MiPCT payment, but can be used for chronic care management of non-attributed Medicare patients. See your PO or biller for details. 99490 for Non- MiPCT patients ($42.00 PEPM)** CMS Practices CMS UMHS (as a pass-through) POs/PHOs ( sent to the entity that pays the care manager)

2 Medicaid Managed Care Funds Flow Upfront Care Coordination ($3.00 PMPM) Retrospective Incentives ($3.00 PMPM) Michigan Department of Community Health POs/PHOs Practices* Michigan Department of Community Health (MDCH) Practices Upfront Practice Transformation ($1.50 PMPM) Michigan Department of Community Health POs/PHOs (sent to entity that employs care manager) *At least 80% of the incentives must be provided to practices by POs/PHOs

3 BCBSM Funds Flow Practice Transformation (Pre- existing uplift)* BCBSM Practices Care Coordination Retrospective Incentives (Pre-existing PGIP Incentive Program)* Existing 10% or 20% E&M Uplift for all PCMH practices BCBSM Practices G/CPT Codes and 5% E&M uplift for practices servicing an acceptable % of patients BCBSM POs Practices * BCBSM has existing practice transformation payments in excess of $1.50 PMPM, as well as incentives exceeding $3PMPM toward MiPCT goals BCBSM Medicare Advantage Care Coordination BCBSM MA Practices G/CPT Codes

4 BCN Funds Flow Practice Transformation ($1.50 PMPM for non- capitated practices)* BCN Practices Care Coordination Retrospective Incentives ($3.00 equivalent)** PMPM to non-capitated practices BCN Practices G and CPT Codes BCN POs Practices * BCN has existing payments equivalent to (or exceeding) $1.50 PMPM for capitated groups for practice transformation **BCN has existing incentive payments. If during any incentive period existing BCN incentive payments do not meet the $3.00 PMPM threshold, BCN will contribute the remainder to the MiPCT incentive pool and pay out incentives equal to the difference between the existing BCN incentive amounts and $3.00PMPM.

5 Priority Health Funds Flow Practice Transformation (pre-existing payments)* Priority Health Practices Care Coordination Incentives ($3.25 PMPM)** Priority Health Practices G and CPT Codes Priority Health Commercial, MA, and Medicaid POs or Practices * Priority Health has existing payments equivalent to (or exceeding) $1.50 PMPM. **Incentives distributed directly by Priority Health contingent on the practice maintaining a 2% engagement rate of Priority Health patients in care management services. Please contact your Priority Health representative for more details. Priority Health Medicare Advantage Care Coordination Priority Health MA Practices G and CPT Codes


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