mipct webinar 10/31/2012
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Michigan Primary Care Transformation
Demonstration Project
October 31, 2012
Agenda
Context and Overview
Payer Updates
• BCBSM
• BCN
• Medicaid
• Medicare
2
Seeking Nomination
MiPCT is soliciting nominations for one slot for a
PO representative with financial expertise on the
Steering Committee.
The purpose of the Steering Committee is to
provide strategic direction to MiPCT Leadership
and monitor progress toward the goals and
objectives of MiPCT.
3
Care Management Reporting
The care management activity reporting
requirements have been finalized and will be
incorporated into the Quarterly Report beginning
in the first quarter of 2013.
Number of Care Manager face-to-face encounters
(by Care Manager, by practice, by primary payer)
4
Care Management Reporting
Number of Care Manager telephone or electronic
encounters by Care Manager, by practice, by
primary payer
Number of unique patients by Care Manager, by
practice, by primary payer
5
PDCM Codes and Fees
6
CODE SERVICE FEE*
G9001 Initial assessment $112.67
G9002 Individual face-to-face visit (per encounter) $56.34
98961 Group visit (2-4 patients) 30 minutes $14.08
98962 Group visit (5-8 patients) 30 minutes $10.47
98966 Telephone discussion 5-10 minutes $14.45
98967 Telephone discussion 11-20 minutes $27.81
98968 Telephone discussion 21+ minutes $41.17
*Net of Incentive amount
New MiPCT Files
MiPCT has sent the most recent data participating
practices and physicians, respectively.
NPs/PAs that serve as PCPs and bill separately
have been added to the file.
The same billing information needed for
physicians is needed for NPs/PAs.
To receive Medicaid payments, the NP/PA must be
the PCP of record for Medicaid managed care
members and must be enrolled in CHAMPS.
7
MDC Dashboard
The first MDC Dashboard is available for MNO and
the practices within it.
This release was constructed using 2010-2011
Medicare and Medicaid claims data and
September attribution lists.
8
MDC Baseline Data
This release provides baseline data for MNO and
each practice for Medicare and Medicaid (as it
reflects data January 2010 through December
2011).
More recent data will be integrated over time and
other payers will be added to aid in identifying
opportunities for improvement (and best
practice).
9
MDC Baseline Data
The next release of dashboards is scheduled for
January 2013 and will include BCBSM data.
Future dashboards will be released every two
months to provide data on your performance over
time.
10
Moderate Care Manager Program
Place: Physicians’ Training Center
26550 John R Madison Heights Mi 48071
Contact: Mike Mellor,
mmellor@transformcoach.org
Modality/schedule: Live, in-person
Course dates: November 6, 7, 14, 15. 8:30am-
4:30pm (Must all four days)
11
Documenting Success Stories
Robert Wood Johnson video submission for
possible full length story
Interviews by national research organization
Interviews by CMS representatives
12
Upcoming Events
Practice meeting to discuss Care Manager
integration
Billing and coding
Group assessment of current quality scores and
gap analysis
Learning Collaborative beginning December 5,
2012
Mini Learning Collaboratives
13
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