TPA specialists receive value-based reimbursements |
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The Physician Alliance is pleased to announce that 97.3 percent of our nominated specialists were selected by Blue Cross Blue Shield of Michigan (BCBSM) to receive the 2022 specialist value-based reimbursement (VBR)! This impressive number highlights the commitment and hard work of specialty practices in implementing patient-centered medical home neighborhood principles to improve patient care.
Value-based reimbursement by the numbers:
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97.3% of TPA PGIP specialty physicians nominated by TPA earned a value-based reimbursement in 2022 (959 specialists representing 269 practices)
- 7.5% of TPA PGIP physicians receive a 5% VBR
- 89.7% of TPA PGIP physicians receive a 10% VBR
- 93% of all TPA specialty physicians in PGIP are receiving a VBR
Physicians selected by BCBSM for the specialist value-based reimbursement received a letter in March 2022 (from The Physician Alliance) informing of the VBR percentage amount.
For additional detailed documentation regarding the specialist value-based reimbursement, including your practice's final results report and a report data dictionary, log into The Physician Alliance member portal. If you need assistance accessing the portal or information on the eligibility and nomination process for the VBR, please contact your practice resource member.
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Incentives to focus on social determinants of health |
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Many patients often face challenges outside of their health concerns that impact their ability to manage their health. The Institute for Clinical Systems Improvement found that 80% of health outcomes are affected by factors outside of the physician's office.
Some of these factors may include social determinants of health (SDOH). These are "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks," according to the Centers for Disease Control and Prevention (CDC). The CDC also states these "resources that enhance quality of life can have a significant influence on population health outcomes." SDOH can include food, shelter, employment, child care, transportation and more.
Challenges in any of these areas can make it difficult for physicians to create a proactive plan addressing a patient's health concerns. But addressing these social determinants of health can be as important as addressing a health concern.
In an effort to address social factors negatively impacting patients' health outcomes, Blue Cross Blue Shield of Michigan is incentivizing providers to focus on social determinants of health. Primary care practices can earn 5% value-based reimbursement (VBR) by completing SDOH screenings. To earn this reward:
Claims reflect SDOH diagnosis codes (Z codes) billed for 2% of Blue Cross patients seen for a well-visit.
The measurement period for VBR effective Sept. 1, 2022 is from Jan. 1 - June 30, 2022. Count of total Blue Cross patients will be determined by claims including the well-visit codes listed below. Patients with SDOH diagnoses will be determined by claims billed for patients with SDOH diagnosis code (Z codes ranging from Z55-Z65) between Jan. 1 - June 30, 2022.
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Initial new patient
preventive medicine evaluation
99381 - Under 1 year
99382 - 1-4 years
99383 - 5-11 years
99384 - 12-17 years
99385 - 18-39 years
99386 - 40-64 years
99387 - 65 years and older
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Established patient periodic
preventive medicine evaluation
99391 - Under 1 year
99392 - 1-4 years
99393 - 5-11 years
99394 - 12-17 years
99395 - 18-39 years
99396 - 40-64 years
99397 - 65 years and older
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Medicare specific
G0402 - Initial preventive physical examination
G0438 - Annual wellness visit - initial
G0439 - Annual wellness visit - subsequent
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New Affiliate Partner helps with print and office needs |
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The Physician Alliance members receive the following Affiliate Partner exclusive offers:
- FREE assessments/audits
- 10% – 20% off printers, copiers, and support
- 20% off shredders, folding equipment, mailing solutions
- 15%+ off HIPAA compliant document management/workflow software/cloud solution
- Up to 40% off HIPAA compliant secure cloud fax
Managed print service features:
- Automatic toner replenishment
- 4-hour guarantee service and support
- Includes toner, parts, labor, service, & training
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Webinar highlights cost of missing HCC codes |
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Is your practice paying the price for overlooking chronic conditions for risk adjustment?
The beginning of the year is the best time to start looking at your patients from a different perspective. Don't miss this special upcoming webinar to help improve coding:
Lunch with the Coder: The cost of missing HCC codes
Wednesday, March 30, 2022; 12-1pm
This webinar will help you better understand:
- adding diagnosis codes that matter!
- how correct diagnosis coding can make all the difference in incentive-based payor programs.
Presenter: Mary Mallory, CEMC, risk coding education manager at The Physician Alliance
Webinars are complimentary and open to The Physician Alliance members only.
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Virtual symposiums help with HEDIS/Stars, coding and more |
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Blue Cross Blue Shield of Michigan is hosting provider symposiums on patient experience of care, HEDIS/STARS, and coding. The virtual programs are open to physicians, office staff and coders.
BCBSM is offering continuing education credits to physicians, physician assistants, nurse practitioners, nurses and coders for attending the sessions. Please contact BCBSM directly with questions or problems relating to these sessions.
The following sessions are for physicians and office staff responsible for closing gaps in care related to quality measures and creating a positive patient experience:
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We are Stars – HEDIS®/STAR measure, details and exclusions
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Patient Experience – providing great
service 2.0
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These sessions are for physicians and administrative, coding and billing staff.
Medical record documentation and coding
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Traditional telephone line services are being phased out |
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Source: Edge Solutions, an Affiliate Partner, provides innovative telecommunications products and services at discounted rates to The Physician Alliance members. Learn more.
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The latest healthcare news |
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Featured Affiliate Partner: CYBER LIABILITY INSURANCE: Huntington Insurance helps practices protect their assets with liability insurance. TPA members receive discounted pricing with multiple physicians policy and low deductibles.
Learn more about this partner and take a cyber risk exposure test.
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