1. PCP and SPC Forum
September 24, 2019

2. ACO/CCM POPULATION 39% 30% ACO/CCM 2018 Providers : 183 Providers
Patients :
ACO_6,558 Patients
CCM_5,037 Patients
ACO/CCM 2019
Providers : 261 Providers
Patients:
ACO _ 11,309 Patients
CCM _ 8,116 Patients
ACO/CCM 2020 proposed
Providers joining us: 14
30%
39%

3. ACO -13:  Falls: Screening for Future Falls​ ( 85% PCP missing this measure)
ACO - 14: Preventive Care and Screening: Influenza Immunization​
ACO - 17: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention​ ( 90% PCP missing this measure)
ACO - 18: Preventive Care and Screening: Screening for Depression and Follow-up Plan​
ACO - 19: Colorectal Cancer Screening​
ACO - 20: Breast Cancer Screening​
ACO - 42: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease​
ACO - 40: Depression Remission at Twelve Months​
ACO - 27: Diabetes Hemoglobin A1c (HbA1c) Poor Control (>9%))​
ACO - 28: Hypertension: Controlling High Blood Pressure ​
QUALITY MEASURES (10)

4. ACO/CCM Superbills ACO/CCM 2018
Superbills Sent in 2018
Q2-Q4
Month
Bills
April 26
May 47
June 91
July
101
Aug
129
Sept
178
Oct
219
Nov
254
Dec
252
Grand Total
1297
ACO/CCM 2018
How many superbills sent out in SUPERBILLS
ACO/CCM 2019
How many superbills sent out From Q1- Q SUPERBILLS
Estimate for Q SUPERBILLS
Superbills Sent in 2019
Q1-Q2
Month
Bills
Jan
241
Feb
179
March
160
April
184
May
225
June
162
Grand Total
1151

5. In-House Billing How will Family Choice ACO CCM In-house Billing Work?
Patient Care Coordinators (PCCs) will continue to enroll eligible patients and create comprehensive care plans as they do daily.
FC ACO will aggerate for all eligible monthly charges and bill Medicare directly.
FC ACO will invoice PCP 45% of CCM allowed amount for performing monthly CCM services
FC ACO will make monthly disbursements to providers along with a copy of summary of EOBs for your records.
FC ACO will bill only one of the below CPT codes monthly.
99490
99487
99489
In-House Billing

6. How can I patriciate? In-House Billing
Sign ACO Participation Agreement Addendum – Chronic Care Management Program
Complete and return Medicare Enrollment Application - Reassignment of Medicare Benefits form 855R
In-House Billing

7. Effective October 1, 2019, Family Choice will charge 45% of total paid claims. (Pending CMS approval)
In-House Billing

8. ACO – PCP Code Specialty

9. ACO – SPC Code Specialty

10. RAF

11. RAF

12. RAF

13. RAF

14. RAF

15. RAF

16. HEDIS

17. HEDIS

18. HEDIS

19. CAHPS Survey

20. CAHPS Survey

21. CAHPS Survey