Updates to the 2018 CPC+ and PCP Incentive Program manuals available

The 2018 CPC+ and PCP Incentive Programs support your efforts to provide the best clinical care while balancing cost and patient experience, a structure that directly reflects the Triple Aim. Updated versions of both manuals are now available for downloading.

2018 PCP Incentive program changes 

Several measures have been updated in the PCP Incentive Program including care management, and risk adjustment. Measure targets and payouts are available for most program measures with the exception of ED PCP treatable care and All-cause readmissions. The target and payout for the ED PCP Treatable Care measure will be available in June 2018. The all-cause readmission target and payout is still being determined but we expect to make it available by the end of February.

Edits to the manual as of Feb. 1, 2018

Print and update your PIP or CPC+ program binder with the following new or revised pages. A brief description of changes is included.

Program deadlines – (PIP and CPC+ pg. 11)

  • Care management attestation survey:

    March 1 – CPC+ sites to receive prospective payment in April
    June 1 – CPC+ sites new to care management or under transition/with a care manager not trained by May 1
    June 1 – PCP practice groups that participate with the PIP program

  • All-cause readmissions: June 1, 2018
  • Risk adjustment education – in-person training dates: May 21 and May 22, 2018
  • Risk adjustment education – webcast and survey attestation: Sept. 14, 2018
  • PMCH recognition – Sept. 14, 2018

Adolescent immunization – (PIP pg.16, CPC+ pg.16)

  • Identified measure section: Changed the immunization set combination 1 to state “immunization set combination 2”.

Colorectal cancer screening – (PIP pg. 23, CPC+ pg. 23)

  • Numerator section: Changed the date range for CT colonography to 2014 – 2018. 

Depression screening and follow-up – (PIP pg. 36, CPC+ pg. 36)

  • Notes section: Added statement 

Senior care education – (PIP pg. 38, CPC+ pg. 38)

  • Identified measure section: Revised statement 

Care management – (PIP pg. 40-44, CPC+ pg. 40-44)

  • Added collaborative care and HCPCS codes
  • Updated the attestation and documentation section
  • Added the risk-adjusted per member per month (pmpm) payment and targets
  • Added measure specific detail to the notes section
  • Added: Practices are eligible for either the PCMH incentive or the care management incentive. If a PCMH practice qualifies for the care management incentive, the higher care management incentive will be paid.

Patient-Centered Medical Home (PCMH) - (PIP pg. 45, CPC+ pg. 45)

  • Identified measure and notes section: Changed the proof of recognition submission date and notes section 

CG CAHPS – (PIP pg. 46, CPC+ pg. 46)

  • Method of measurement section: Revised statement

All-cause readmissions – (PIP pg. 48, CPC+ pg. 48)

  • Identified measure section: Changed attestation deadline 

Risk adjustment – (PIP pg. 51-52, CPC+ pg. 51-53) Payout and notes section:

  • Added ACA individual and Medicare payout
  • Added the following statement: practices that are certified as participating in Priority’s Advanced Health Assessment (AHA) program prior to June 1 are not eligible for the risk adjustment measure.
  • Added deadline dates for each of the risk adjustment measure requirements 

Codes set

  • (PIP pg. 76-77, CPC+ pg. 77-78) Hypertension and nephropathy drug subclasses
  • (PIP pg. 86, CPC+ pg. 87) Care management – added codes 99492, 99493, 99494, G0511, G0512 

Report #70 

  • (PIP pg. 95-98, CPC+ pg. 95-98) Instructions

Go to the PCP Incentives Program (PCP IP) or CPC+ Incentives Program page to download the 2018 measures chart and manuals.

Questions? Contact your Provider Performance Specialist. They can help you meet your program objectives.