Before our discussion of the term past medical history (PMH), let’s briefly reflect on the risk adjusted payment paradigm, or MRA as it’s known in Medicare Advantage circles. CMS bases the bulk of the capitation payment made to MA plans on the health status of the patient, as reflected by the conditions reported by a healthcare provider. CMS guidelines state that the ICD-10-CM codes for these diagnoses are reported in a face-to-face encounter with an authorized provider who has “monitored, evaluated or treated” them. This means that payment is not warranted because the patient merely has a medical condition that prompts a risk-adjusted payment, but because the provider did something about the condition (e.g., monitored, evaluated or treated).
PMH is generally defined as a medical condition the patient had, with emphasis on the past part of the phrase. Logically, one would believe that a diagnosis in the PMH is resolved but perhaps for surveillance or other reasons, the provider wants to preserve its history by mentioning it in a section of the chart and visit note.