Commercial Revenue Reporting


Reporting Your CPC+ 2018 Michigan Commercial Revenue to CMS
Overview and What To Expect from Michigan Payers: A Quick Tips Sheet

Overview of CMS’ New Approach to Revenue Reporting

Based in part on feedback from Michigan payers and practices, CMS has made several changes to simplify and improve CPC+ financial reporting for 2018.  We are grateful to CMS for listening to our concerns and responding to them:

  • Revenue Reporting Period Shifted to First Two Months of 2019:
    • Practices will now have between 1/1/19 and 2/28/19 to submit PY2018 financial reporting.  This period also aligns with eCQM reporting.
  • No Required Forecast:
    • Previously, all practices submitted a prospective financial forecast for their CPC+ revenues and expenditures
    • Going forward, you will only need to submit your retrospective actual revenues and expenditures.
  • No Revenue Breakouts Required:
    • You will no longer have to breakout payer partner payments by type (care management fee, FFS alternative, etc.), or break out your labor expenses by activity.

How Michigan Commercial Payers Will Help POs and Practices

  • The following information to be reported for each commercial payer’s revenue received in 2018: 1) the number of attributed CPC+ commercial members; 2) the amount of revenue (i.e., care management G and CPT codes, incentive, Value-Based Reimbursement, etc.) that each practice received from each commercial payer for its CPC+ attributed members. The reports will be distributed to POs for each of their practices for distribution to their practices by February 5, 2019.
    • BCBSM will distribute practice-specific reports to POs that detail the revenue disbursed to each CPC+ practice for its attributed CPC+ BCBSM membership. The reports will use the latest and most complete data available.  Thus, reports will likely cover a twelve-month period from November 2017 to November 2018 which should be reported as 2018 revenue to CMS; more recent data will be provided if available.  If you have questions about these payments for your CPC+ members, please contact your PGIP Field Representative.
      If your practice is not PCMH PGIP-designated, the only CPC+ payment you would reflect is related to Clinical Quality VBR and G/CPT codes billed for provider-delivered care management.  Note that this applies to only a very small number of practices.
    • Priority will distribute practice-specific reports to ACNs that detail the revenue disbursed to each CPC+ practice for its attributed CPC+ Priority membership. The reports will use the latest and most complete data available and are anticipated to cover the entire 2018 calendar year’s revenue.
    • HealthScope did not have 2018 commercial membership in Michigan in CPC+, and thus will not distribute reports, but are actively working on achieving CPC+ participation from its self-insured customers.

 This Quick Guide was prepared in partnership with Michigan CPC+ payers
by the Multipayer Initiatives Team at the University of Michigan.