tci Medicare Compliance & Reimbursement - 2019 Issue 10
Pocket This Primary Care First Breakdown
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Article Overview
This article explains CMS’s Primary Care First initiative and summarizes the two payment model options available under it. It is aimed at primary care clinicians, practice administrators, and coding or reimbursement professionals who want a high-level understanding of how the program is structured, what broad participation requirements are discussed, and why the model matters in the shift toward value-based care.
Why This Topic Matters
The piece matters because it highlights a CMS payment approach that ties primary care reimbursement to performance, patient risk, and care delivery capabilities. Practices considering participation can use it to quickly gauge whether the program’s general framework and eligibility themes are relevant to their organization.
Article Sections
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Review the 2 Primary Care First Payment Model Options
Introduces the two Primary Care First model options and explains the article’s focus on program structure and payment approach.
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Eligibility requirements
Summarizes the broad participation themes discussed for primary care practices, including location, beneficiary volume, payer mix, experience, and technology expectations.
What You Will Learn
- How CMS is framing the Primary Care First initiative
- The general differences between the two Primary Care First payment options
- The broad participation themes and practice characteristics discussed in the article
- How the initiative fits into the larger shift toward value-based primary care payment
Who Should Read This
- Primary care physicians
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
- Practice administrators
- Medical billing and reimbursement professionals
- Healthcare compliance staff
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