News

2018 Primary Care Provider Quality Reward Program

We understand the 2017 Risk Adjustment Factor (RAF) reward using CPT code 99429 was a challenge operationally. Therefore, we structured the 2018 incentives to be easier to manage, as providers are often asked to document for many patients. The Annual Wellness Visit (AWV) quality reward is claim-based, so the provider may simply submit one of the 3G codes. We want to make the process for providers as smooth as possible so you may concentrate on patient care.

Quality Reward Program metrics:

Quality Metric Amount of Reward Eligible Members Description Payment Frequency Billing Codes
Annual Wellness Visit $100 Per Member Per Year Premier Medicare Advantage (MA) Providers who perform an Annual Wellness Visit (AWV) on Premier MA members will receive a quality reward of $100, eligible once per member per year. Providers are encouraged to complete a patient assessment form (PAF) during the AWV. This is in addition to normal fee-for-service rates for this type visit. Quarterly G0402
G0438
G0439
Physician Coding/Risk Adjustment Training $250 per physician, Nurse Practitioner (NP) or Physician Assistant (PA) N/A Physicians, NPs or PAs who attend a PHG-sponsored coding/risk adjustment training in-person or via a registered on-line webinar at least 1X per year (training will be offered quarterly) will receive a once-annual quality reward of $250. We hope to offer CME credits. Yearly N/A

If you have any questions, please contact us at (937) 499-7441(937) 499-7441

Back to the December 2017 Issue