ED Coding & Reimbursement Alert - 2016 Issue 14
Part B Payment: CMS Launches Primary Care Model, Impacting 20,000 Clinicians
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Article Overview
This article covers CMS’s launch of the Comprehensive Primary Care Plus (CPC+) model and explains how the program is intended to change primary care payment and care delivery. It is relevant to physicians, other primary care clinicians, practice managers, and revenue cycle professionals who need to understand the program’s structure, participation timeline, and general operational impact. The article also summarizes statements from professional organizations and notes the types of practice capabilities and care coordination expectations discussed by CMS.
Why This Topic Matters
CPC+ is presented as a significant shift in how primary care practices may be paid and organized, with implications for reimbursement flow, care management operations, and participation decisions for affected practices.
Article Sections
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CMS announcement and program overview
Introduces the new primary care payment model, its launch timeline, and the scope of expected participation. Summarizes the broad goals CMS associates with the initiative.
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Payments differ based on track
Describes the two participation tracks and the general categories of services and payment approaches associated with each. Also notes the model’s performance-based payment concepts.
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Primary care doctors celebrate the shift
Summarizes reactions from primary care organizations and specialty groups to the new model. Highlights why professional societies view the program as important for primary care delivery.
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Application timing and eligibility
Covers when practices may apply, how regional participation affects eligibility, and the general process for being considered for the program. Notes that participation depends on meeting program requirements.
What You Will Learn
- What CMS is trying to accomplish with the new primary care model
- How the two participation tracks differ at a high level
- Which types of practices and clinicians the program may affect
- What organizations said about the initiative
- When practices may be able to apply and what broad eligibility factors are involved
Who Should Read This
- Primary care physicians
- Family medicine practices
- Internal medicine clinicians
- Practice administrators
- Medical coders and billers
- Revenue cycle staff
- Health policy readers
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