Medicare Compliance & Reimbursement

Can you provide enhanced office hours and 24/7 access?

Before you jump on-board with the new Comprehensive Primary Care Plus (CPC+) model, you’d better take a closer look at what the Centers for Medicare & Medicaid Services (CMS) will require from your primary care practice to participate. Nabbing those extra incentive payments won’t be easy, and you’ll have to repay the extra reimbursement if you don’t measure up.

The CPC+ model requires participating practices to offer the following key primary care functions:

1. Access and Continuity: Services must be accessible and responsive to an individual’s preference. Patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access.
2. Care Management: Patients at highest risk receive proactive, relationship-based care management services to improve outcomes.
3. Comprehensiveness and Coordination: Care is comprehensive and your practice must meet the majority of each individual’s physical and mental health care needs, including prevention. You must also ensure that care is coordinated across the healthcare system, including specialty care and community services. Patients must receive timely follow-up after emergency room or hospital visits.
4. Patient and Caregiver Engagement: The care model is patient-centered, recognizing that patients and family members are core members of the care team. You must actively engage patients to design care that best meets their needs.
5. Planned Care and Population Health: The care model measures quality and utilization of services, and analyzes data to identify opportunities for improvements in care and to develop new capabilities.