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Published byJasmin Anderson Modified over 6 years ago
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Medicare Funds Flow CMS Practices CMS Practices CMS CMS
Upfront Practice Transformation ($2.00 PMPM) Upfront Care Coordination ($4.50 PMPM) Retrospective Incentives ($3.00 PMPM) 99490 for Non- MiPCT patients ($42.00 PEPM)** CMS Practices CMS UMHS (as a pass-through) POs/PHOs CMS Practices CMS UMHS (as a pass-through) POs/PHOs (sent to the entity that pays the care manager) 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.
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Medicaid Managed Care Funds Flow
Upfront Practice Transformation ($1.50 PMPM) Upfront Care Coordination ($3.00 PMPM) Retrospective Incentives ($3.00 PMPM) Michigan Department of Community Health (MDCH) Practices Michigan Department of Community Health POs/PHOs (sent to entity that employs care manager) Michigan Department of Community Health POs/PHOs Practices* *At least 80% of the incentives must be provided to practices by POs/PHOs
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BCBSM Funds Flow POs BCBSM BCBSM Practices Practices BCBSM MA
Practice Transformation (Pre-existing uplift)* Care Coordination Retrospective Incentives (Pre-existing PGIP Incentive Program)* BCBSM Medicare Advantage Care Coordination BCBSM Practices BCBSM Practices BCBSM POs Practices BCBSM MA Practices Existing 10% or 20% E&M Uplift for all PCMH practices G/CPT Codes and 5% E&M uplift for practices servicing an acceptable % of patients G/CPT Codes * BCBSM has existing practice transformation payments in excess of $1.50 PMPM, as well as incentives exceeding $3PMPM toward MiPCT goals
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BCN Funds Flow POs BCN Practices BCN Practices Practices BCN
Care Coordination Retrospective Incentives ($3.00 equivalent) Practice Transformation ($1.50 PMPM for non-capitated practices)* BCN Practices BCN Practices BCN POs Practices PMPM to non-capitated practices G and CPT Codes * BCN has existing payments equivalent to (or exceeding) $1.50 PMPM for capitated groups for practice transformation
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Priority Health Funds Flow
Care Coordination Practice Transformation (pre-existing payments)* Incentives ($3.25 PMPM)** Priority Health Medicare Advantage Care Coordination Priority Health Practices Priority Health Practices Priority Health Commercial, MA, and Medicaid POs or Practices Priority Health MA Practices G and CPT Codes G and CPT Codes * Priority Health has existing payments equivalent to (or exceeding) $1.50 PMPM. **Incentives distributed directly by Priority Health contingent on the practice maintaining a 3% engagement rate of Priority Health patients in care management services. Please contact your Priority Health representative for more details.
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