Using the dashboard below, select CBSA(s), Billing Organization(s), and/or enter Performing NPI(s) for provider(s) that you are interested in.
Hover over the dashboard to see the calculations methodologies for a respective provider.
Note: This analysis is limited to the combination of Billing NPI x Performing NPI with more than 100 attributed beneficiaries. Please also note, not all counties have a Geographic Adjustment Factor (GAF) value; therefore, the adjusted total primary payment will not be populated for billing organizations that are located in the counties without a GAF.
Please refer to the Frequently Asked Questions section below the analysis. Should you have any additional questions, please reach out to your main point of contact at CareJourney for more information and/or additional support in calculating Primary Care Payments under PCF.
Q: If I enter into Primary Care First, how many years will I be enrolled in this payment model?
A: According to CMS, Primary Care First will be tested over six performance years, with two staggered cohorts of participating practices, each participating for five performance years. One cohorts will participate in the model from 2021 through 2025 and a second will participate 2022 through 2026.
Q: How do I know if I am eligible to participate in Primary Care First?
A: Practices located in the 26 regions (listed below) that are not currently participating in CPC+ are eligible to participate in the first cohort of Primary Care First.
Note: These practices are not eligible to participate in the second cohort, which will only include current CPC+ practices.
Q: As a Health Plan, how long do I have to decide if I want to participate in the PCF Model?
A: The solicitation period for payers runs from December 9th, 2019 through March 13, 2020.
Additional Information is available on the CMS Innovation Center website
Q: How are beneficiaries attributed under Primary Care First?
A: Attribution is based on the PCF claims-based, prospective assignment attribution methodology. Attribution in CareJourney is based on claims activity from 2017 and 2018. With the exception of beneficiaries who have already voluntarily aligned, claims-based attribution follows two-step:
First, eligible beneficiaries are to the practice group that billed an Annual Wellness Visit (AWV) or Initial Preventative Physical Examination (IPPE) Visit 24 months prior. If multiple practice groups billed an AWV or IPPE, the eligible beneficiary is attributed to the practice group that billed the latest AWV or IPPE.
Second, if no AWVs or IPPEs were billed, then the eligible beneficiary is attributed to the practice group that billed the plurality of primary care visits and eligible CCM services in the 24 months prior. If a beneficiary has an equal number of qualifying visits and eligible CCM services billed by more than one practice, as measured by a discrete count of services, the beneficiary will be attributed to the practice with the most recent visit.
Q: How is the leakage rate calculated?
A: Leakage rate is calculated at the NPI level based on primary care visits or qualifying CCM in the prior year. Calculated leakage rates in CareJourney are based on claims activity from 2018. The calculation used to determine leakage is: 1 - (total number of primary care visits or qualifying CCM by the beneficiary’s attributed provider / total number of primary care visits or qualifying CCM)
Q: How do you determine if a beneficiary is eligible for attribution under PCF?
A: In order for a beneficiary to be eligible for attribution under PCF, they have to fulfill the following criteria listed below. CareJourney considered the first 3 terms of beneficiary eligibility in attribution calculations.
Q: What years are the data from?
A: The data elements and their years can be found below.
Q: I'm looking for a provider that does not show up because they have less than 100 beneficiaries attributed to them. How do I get their data?
A: Please reach out to info@carejourney.com to discuss this analysis.
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