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.

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