The Pulse of The Physician Alliance
TPA practices earn value-based reimbursement
Blue Cross Blue Shield of Michigan recently selected 90 percent of specialty physicians nominated by The Physician Alliance to receive the value-based reimbursement (VBR).
Congratulations to these physicians!
The Physician Alliance is pleased to share these updates:
- 805 TPA specialty physicians participating in the Physician Group Incentive Program earned a VBR (90% of physicians nominated by TPA)
- 486 physicians receive a 5% VBR
- 319 physicians receive a 10% VBR
- 89% of all TPA specialty physicians in PGIP are receiving a VBR
- 77 TPA PGIP specialty physicians also earned a 3% CQI VBR*
Physicians selected by BCBSM for the value-based reimbursement were notified by The Physician Alliance via letter of the percentage amount. Additional detailed documentation, including the practice's final results report, can be found on TPA's secure physician portal.
*The CQI value-based reimbursement is for participation in a hospital-based clinical quality initiative; a program separate from the specialty value-based reimbursement.
Seminar focuses on improving care management billing
The Physician Alliance and Blue Cross Blue Shield of Michigan are hosting a special education program focused on
Provider Delivered Care Management coding and billing. The seminar is
Wednesday, April 18, 2018 from 8-9:30am at St. John Oakland Hospital Education Building in Madison Heights.
Participants will gain an increased understanding of:
- General billing and documentation guidelines for the BCBSM PDCM codes
- Code specific requirements of the 12 BCBSM PDCM codes
- Patient eligibility for PDCM benefit in the Blue Cross Commercial and Medicare Advantage populations
Who should attend: Billing staff, care managers, office managers and physicians.
About the presenter: Lori Boctor
has been employed with Blue Cross Blue Shield health plans for over 32 years working throughout the Midwest region in different corporate capacities. She is currently a senior analyst with Value Partnerships- Reimbursement team. Lori has a vast understanding of the PDCM care management codes to support PDCM.
Michigan Rx Card saves patients money on prescriptions
Michigan residents have access to a statewide Prescription Assistance Program (PAP) through the Michigan Rx Card. Free discount prescription drug coupon cards can be downloaded and printed from the Michigan Rx Card website, or the app can be downloaded to smartphones. This pharmacy coupon card can provide Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including Walgreens, Rite Aid, Kroger, CVS/pharmacy, Walmart, and many more.
All residents are eligible to get pharmacy discounts through this program, even those with private insurance. The program can be used to supplement most health insurance plans including Health Savings Accounts (HSA) and High Deductible Plans. It can also be used as a Medicare Part D supplement by providing discounts on non-covered drugs.
For more information on this program for patients and employees, visit the Michigan Rx Card website, or contact Deb Adler, outreach program director for the Michigan Rx Card, at (770) 313.7261 or firstname.lastname@example.org.
Teach pediatric patients about healthy lifestyles
Unhealthy body weight in the United States has become alarmingly high. It is estimated that one-half of children and adolescents are overweight, with 33 percent considered obese. Managing health and weight at a younger age can help lead to healthier adults.
The Pediatric Childhood Weight Management program at St. John Hospital helps provide overweight children with a structured, multi-disciplinary approach to achieve healthier body weights, increase their knowledge about healthy living and improve the quality of their lives. The program focuses on children 7-18 years old with a body mass index (BMI) greater than the 85th percentile for age and gender.
The 12-week program includes an i
12 weekly group sessions, f
ollow-up evaluation and long-term follow-up evaluations.
The cost for the program is $500.00 with a discount of $250.00 until April 30, 2018 (these services are not a covered benefit with insurance and are an out of pocket cost to the patient).
Patients must be referred by physicians. For more information on this program, call (313) 343-7047.
Medical office space available
Are you ready to expand or move your practice? Consider these available spaces:
Medical office suites available at
29150-29200 Harper in St. Clair Shores.
uilt in 2006
75 parking spaces
7,100 square feet medical office
- 10+ exam rooms and x-ray room
- 4 private physician offices
- 1,300 SF attic/storage space
2,900 square feet physical therapy office
- Therapy pool
- Exercise and treatment areas
- 2 restrooms with showers
Various sale or lease opportunities available.
Contact Michael Pulcini at (586) 212-0755 or
Sharecare Health Data Services
provides HIPAA compliant medical record copying services. With updated technology, quick turnaround and free copying services for TPA members, this partner can help with your practice's needs.
The Physician Alliance | 20952 Twelve Mile, Suite 130, St. Clair Shores MI 48081 | 586-498-3555
email@example.com | www.thephysicianalliance.org