(The Patient Centered Medical Home continued) aCO, or submission of claims with codes for chronic care management services (with the ability to document compliance in the event of an audit). given the diversity and evolving nature of such requirements, interested practices should consult payors in their region. The national association of state Health Plans (nasHP) provides up to date information on state-specific PCmH payments at www.nashp.org/med-home-map. Claims Data to Support PCMH In order to be eligible for payment based on quality measures, practices must report on performance. There are a number of mechanisms for reporting, and payors or regional quality initiatives may have varying requirements. medicare’s PQRs offers multiple reporting options, including use of registries, group practices, emR, and claims. Claims reporting uses CPT Category II and g-codes. using such codes allows practices to document the performance of services for which they are not billing separately, and provides results on clinical parameters that are part of quality measures. listed on the previous page are two examples of such coding for quality organized by the Cms PQRs program. With the use of these codes, providers can also run reports in their billing system to assess performance on quality indicators. The Primary Care Development Corporation (PCDC) is a New York-based organization with national experience in providing capital and performance improvement facilitation to support PCMH transformation. PCDC has assisted dozens of practices with transformation to this model. Authors William Rollow, MD, is PCDC’s consulting medical director. Deborah Johnson-Ingram (djingram@pcdc.org) is PCDC’s senior program manager. Julie Peskoe (jpeskoe@pcdc.org) is PCDC’s senior project manager. PCDC’s website is www.pcdc.org. Resources 1 sia C, et. al. “History of the medical Home Concept.” Pediatrics 2004;113;1473 2 www.aafp.org/dam/aaFP/documents/practice_management/ pcmh/initiatives/PCmHjoint.pdf 3 www.pcpcc.org/guide/benefits-implementing-primary-caremedical home 18 HBma BIllIng • maRCH.aPRIl.2014 Leap over your competition in a single bound by becoming accredited. Our personal accreditation coaches at HQAA help you look at your organization from a whole new perspective, and support you to maximize quality. And our web-based tools help you organize your policies and procedures to streamline your business and enhance e!ciency. Aim high. Choose accreditation. Visit us at HBMA booth #505. 866.909.4722 www.HQAA.org/billing
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