PCP and SPC Forum September 24 2019 1

PCP and SPC Forum September 24, 2019 1

ACO/CCM POPULATION v ACO/CCM 2018 ü Providers : ü Patients : ü ü Ø ACO_6, 558 Patients Ø CCM_5, 037 Patients ACO/CCM 2019 Providers : 261 Providers Patients: 11, 309 Patients CCM _ 8, 116 Patients ACO _ ü ACO/CCM 2020 proposed ü Providers joining us: 14 ACO/CCM Patients Count 11309 12000 ACO/CCM Patients Count v 183 Providers 39% 10000 8116 6558 30% 5037 6000 4000 2000 0 2018 ACO Patients Count 2019 CCM Patients Count 2

ACO -13: Falls: Screening for Future Falls ( 85% PCP missing this measure) ACO - 14: Preventive Care and Screening: Influenza Immunization QUALITY MEASURES (10) ACO - 17: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention ( 90% PCP missing this measure) ACO - 18: Preventive Care and Screening: Screening for Depression and Follow-up Plan ACO - 19: Colorectal Cancer Screening ACO - 20: Breast Cancer Screening ACO - 42: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease ACO - 40: Depression Remission at Twelve Months ACO - 27: Diabetes Hemoglobin A 1 c (Hb. A 1 c) Poor Control (>9%)) ACO - 28: Hypertension: Controlling High Blood Pressure 3

Superbills by Month 2018 Q 2 -Q 4 Superbills Sent in 2018 Q 2 -Q 4 Superbills Count 300 254 250 252 Month Bills Dec April May June July Aug Sept Oct Nov Dec 26 47 91 101 129 178 219 254 252 Grand Total 1297 219 178 200 129 150 91 100 47 26 50 101 0 April May June July Aug Sept Oct Nov Month_2018 Superbills by Month 2019 Q 1 -Q 2 Superbills Sent in 2019 Q 1 -Q 2 Superbills Count 300 Month Bills Jan 241 Feb 179 150 March 160 100 April 184 50 May 225 June 162 Grand Total 1151 250 241 225 179 200 184 160 162 0 Jan Feb March April May June ACO/CCM Superbills v ACO/CCM 2018 v How many superbills sent out in 2018 1297 SUPERBILLS v ACO/CCM 2019 v How many superbills sent out From Q 1 - Q 2 v 1151 SUPERBILLS Estimate for Q 3 1300 Month_2019 4 SUPERBILLS

How will Family Choice ACO CCM In-house Billing Work? ü ü ü Patient Care Coordinators (PCCs) will continue to enroll eligible patients and create comprehensive care plans as they do daily. FC ACO will aggerate for all eligible monthly charges and bill Medicare directly. FC ACO will invoice PCP 45% of CCM allowed amount for performing monthly CCM services FC ACO will make monthly disbursements to providers along with a copy of summary of EOBs for your records. FC ACO will bill only one of the below CPT codes monthly. o 99490 o 99487 o 99489 In-House Billing 5

How can I patriciate? Sign ACO Participation Agreement Addendum – Chronic Care Management Program Ø Complete and return Medicare Enrollment Application Reassignment of Medicare Benefits form 855 R Ø In-House Billing 6