tHe journAL oF tHe HeALtHCAre bILLIng And MAnAgeMent ASSoCIAtIon 13 documentation to confirm that the practice meets the requirement. For each requirement that is met, the practice is awarded points. If a specified number of points are met, the element is passed. total points are summed across all elements and standards. A practice can achieve three levels of recognition based on points scored and whether it has passed on a subset of elements that are designated as “Must Pass.” Figure 3 summarizes the three levels of recognition. TransformaTion To PCmH to become a PCMH, most practices must undergo substantial change: a PCMH transformation. the transformation may include a practice moving: • from focus on individual patients to management of a population of patients; • from reactive care based on how a patient presents to proactive care that seeks to prevent problems and optimize outcomes; • from physician care to team care; • from practice-focused care to care that coordinates with external providers and with the patient/family/caregiver; • from paper medical records to electronic records, registries, and communication methods; and • from unmeasured performance to measured performance. FEATURE Story FIGURE 1. NCQA Standards and Elements FIGURE 2. Example of a Factor Statement Within an NCQA Element and Standard FIGURE 3. Levels of NCQA PCMH Recognition Recognition Levels Level 1 Level 2 Level 3 Required Points 35–59 points 60–84 points 85–100 points Must-Pass Elements 6 of 6 elements are required for each level Score for each Must-Pass element must be ≥ 50% Intentionally blank
Billing_MA14
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