April 14, 2016

The (Upgraded) Morale Booster Plus You

You may have already heard that the Centers for Medicare and Medicaid Services (CMS) has recently revealed its newest and biggest initiative to not only increase efficacy, but to completely revolutionize the primary care field in the United States. This new endeavor is built upon the current system, Comprehensive Primary Care (CPC), and is very appropriately named the Comprehensive Primary Care Plus (CPC+) model. This new model will accommodate up to 5,000 practices, which can beset over 20,000 providers. This translates to approximately 25 million patients! One of the main goals is to place a cleft in the interdependence from office-based visits and reimbursement. This will allow providers greater flexibility to care for their patients in more ways than one – whether they are physically with them in a room or communicating through a secure email-based system. Whichever outcome, not only is a patient being treated with top-notch care and accessibility but the provider is also achieving results and getting paid for them too. This new endeavor is not only limited to Medicare beneficiaries. The CMS will be partnering up with private insurers to broaden the scope of how qualified the system truly is.

CPC+ will be delving further into the plunges of managed healthcare than the original CPC program. There will be two tracks for primary-care providers to participate in. According to CMS, “in Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.” Track two has greater rewards but should be treaded lightly as risks are far more evident. And in the spirit of rewards, practices in both tracks will reap from advanced incentive payments that they will either enjoy or recoup based on their achievements in quality and usage.

The new initiative was met with plenty of positive approvals. The American College of Physicians’ (ACP) president, Dr. Wayne J. Riley, said that “CPC+ offers the potential of greatly strengthening the ability of internists and other primary care clinicians, in thousands of practices nationwide, to deliver high value, high performing, effective, and accessible primary care to millions of their patients.” Others like Wanda Filer, MD, the president of the American Academy of Family Physicians, said “This model makes sure patients are getting the right kind of care, at the right time.” Many are voicing their excitement for the new initiative as well as their noting the success of such a project.

CMS will begin accepting payer propositions to participate in CPC+ from mid-April through the first of June 2016. Consequently, they will be accepting primary-care practice propositions in qualifying regions mid-July through September 2016.

The Medical Business Partners team is definitely feeling the zeal in the air!  The new approach is a welcome morale booster for practices all over North America. As always, we cannot stress enough how vital it is for a practice to work with a billing company that changes with the times, and plans for the future trends and initiatives! Being proactive with updates to insurance policies and procedures, analyzing reports, and implementing the most effective revenue cycle model is truly one of the most essential parts to securing a successful future in private practice! The upcoming CMS changes will eventually affect all healthcare providers. Though it’s currently a pilot for primary care practices, there is a strong possibility of it spreading to other specialty practices when success is high (which it has been – CMS met its ambitious goal with CPC, 11 months ahead of schedule!). If you need help getting ready for this new CMS proposal or would like a comprehensive analysis done of your current financial situation, please reach out to our team and we’ll be happy to assist you in preparing for what’s ahead!

For further reading, please check out: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-04-11.html and visit Medical Business Partners at www.medicalbusinesspartners.com.

About Kate G
Kate is a multi-hyphenated billing and coding fanatic and a highly caffeinated cycle revenue dreamer.