Reporting Commercial CPC+ 2019 Revenue to CMS
Background
CMS requires CPC+ practices to submit information on revenue received from commercial payers for the 2019 calendar year. This Quick Tips Sheet for Reporting Michigan CPC+ Commercial Revenue was designed to assist in your reporting. In Michigan, as in several other regions, CPC+ practice payments from commercial CPC+ payers (BCBSM and Priority Health) are part of contractual arrangements that existed prior to CPC+.
How Michigan Commercial Payers Will Help POs and Practices
- The elements for you to include for each commercial payer’s revenue received in 2019 (illustrated on page two of this guide) are: 1) the number of attributed CPC+ commercial members and how often payment is issued; 2) the amount of revenue (i.e., including care management G and CPT codes, incentives, Value-Based Reimbursement, etc.) that each practice received from each commercial payer for its CPC+ attributed members; 3) the percent of such payments that were tied to cost or quality performance; and 4) the amount of bonus you received in 2019 for an earlier (e.g., 2018, etc.) year that was related to CPC+ commercial revenue.
- The deadline for practice reporting to CMS is February 28, 2020.
- In advance of this deadline, to ease the burden of reporting on practices, each Michigan participating CPC+ payer partner (BCBSM and Priority Health) will distribute reports to POs for each of their CPC+ practices for distribution to their practices as follows:
- BCBSM will distribute practice-specific reports to POs that detail the revenue disbursed to each CPC+ practice for its attributed CPC+ BCBSM membership by February 10, 2020. The reports will use the latest and most complete data available. Thus, reports will cover a twelve-month period from January 2019 to December 2019 that should be reported as 2019 CPC+ revenue to CMS. 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 Health will distribute practice-specific reports to ACNs (POs) that detail the revenue disbursed to each CPC+ practice for its attributed CPC+ Priority membership by February 21, 2020. The reports will use the latest and most complete data available and are anticipated to cover the entire 2019 calendar year period.
- BCBSM will distribute practice-specific reports to POs that detail the revenue disbursed to each CPC+ practice for its attributed CPC+ BCBSM membership by February 10, 2020. The reports will use the latest and most complete data available. Thus, reports will cover a twelve-month period from January 2019 to December 2019 that should be reported as 2019 CPC+ revenue to CMS. If you have questions about these payments for your CPC+ members, please contact your PGIP Field Representative.
This Quick Guide was prepared in partnership with Michigan CPC+ payers
by the Multipayer Initiatives Team at the University of Michigan.
