A bi-weekly newsletter from your physician organization


Friday, Nov. 4, 2022

New incentive availabe for postpartum screening


One out of seven women will be diagnosed with postpartum depression after giving birth. However, only 20 percent will report their symptoms to their providers. 

The American College of Obstetrics and Gynecologists recommends that providers screen patients for major or minor depression episodes within 12 months of delivery.

A Postpartum Depression Screening & Follow-up HEDIS measure will begin in 2023 and Blue Cross Blue Shield of Michigan (BCBSM) will offer incentives to eligible obstetricians and gynecologists participating in their Physician Group Incentive Program (PGIP). 

OB/GYNs aligned to a physician organization (PO) that meets or exceeds a 90-day post-delivery postpartum depression screening rate of 50% for attributed deliveries occurring between 10/1/2022 - 3/31/2023 will earn an additional 3% value-based reimbursement (VBR) for the spring VBR 2024 cycle (VBR payment period 3/1/2024 – 2/28/2025). BCBSM anticipates raising the screening threshold for each performance year. 

Important items to note: 

  • The metric includes both live and stillbirth deliveries in the denominator.
  • Deliveries will be attributed to an OB/GYN using the attribution logic in the women’s health dashboard.
  • Screenings and deliveries will be attributed to the PO of the OB/GYN for a PO-level rate calculation.

Postpartum depression screening codes:

ICD-10 Dx Codes: 

  • Z13.30: Encounter for screening examination for mental health and behavioral disorders, unspecified
  • Z13.31: Encounter for screening for depression
  • Z13.32: Encounter for screening for maternal depression

CPT Codes:

  •  96127: Behavioral health assessment

For more information on this incentive, please contact your practice resource team member. 

Blue Cross changes provider engagement incentive

Blue Cross Blue Shield of Michigan (BCBSM) recently announced changes to the Advantasure Provider Engagement Coordination (PEC) program incentive payout. For payment year 2023, the incentive payout changes aim to help improve member care and appropriately capture HCC coding and illnesses. 

The Centers for Medicare & Medicaid Services (CMS) require that certain chronic conditions be addressed and documented in the medical record at least once every calendar year. The PEC program works with primary care providers to improve documentation in the medical record to accurately reflect the severity of illness of their Medicare Advantage members. The program guides, but does not direct, providers on what they should document.

Current payout

  • Pay incentive on full panel regardless of visit with provider
  • Pay based on predetermined levels only
  • Limited opportunity for providers to improve to receive larger incentive payout
  • Limited data and reporting available to providers and PO’s

New payout

  • Pay incentive only for members who have visit with provider
  • Pay based on predetermined levels as well as HCC chronic persistency improvement
  • Greater opportunity for providers to improve to receive larger incentive payout
  • Enhanced data and reporting available to providers and PO’s

Items to note:

  • Persistency is based on chronic conditions (HCCs) captured in the prior year. Chronic status of a condition is based on prior ICD-10 codes found with chronic mapping provided by the Agency for Healthcare Research and Quality.
  • Persistency incentive is not cumulative.
  • Under the new incentive structure, once the tier of persistency level is established, there is no improving tiers in the current year. However, increases in the current year persistency could improve the tier for the following year.
  • Persistency reporting will accompany current PEC reporting and is provided by BCBSM.
  • Focus of the new persistency incentive is to promote complete and accurate documentation and coding. Persistency can be improved by condition capture and condition removal (whether removal of prior condition incorrectly coded or condition resolution with appropriate clinical documentation).
  • All incentives will be paid out at the same time.
  • Additional FAQ documents will be provided by BCBSM at a later date.

Please contact your BCBSM representative with questions or for more information on this incentive change.

More care management training dates announced

The Physician Alliance practices can participate in education programs focused on improving care management. These programs are open only to TPA member practices

Introduction to Team-Based Care

November 16, 2022 - 8am - 2:30pm

Live Virtual

The Introduction to Team-Based Care course helps the learner better understand how to work in a multidisciplinary care team and in collaboration with the patient. Open to all members of the practice to gain foundational knowledge in team-based care. Introduction to Team-Based Care will include:

  • Why, what, who and how: team-based care
  • Care management process
  • Outcomes and Triple AIM
  • Billing applications

Trainer(s): Sharon Kraydich, Lisa Davis

Registration Deadline: November 15, 2022 at 5pm - REGISTER NOW

Limited space.

Foundational Care Management Codes & Billing Opportunities

December 9, 2022, 8am - 12pm

Live Virtual

The Foundational Care Management Codes & Billing Opportunities course builds upon team-based care focusing on reimbursement for care management services for BCBSM and Priority Health (some details discussed may be similar for other payers). This course is designed to support and train physician organizations and practice staff on care management billing. Topics will include:

  • Care team coding and billing is a team sport
  • Billing optimization
  • Billing applications
  • Billing resources

Trainer(s): Sharon Kraydich


Registration Deadline: Dec. 8, 2022 at 5pm - REGISTER NOW

Limited space.

Don't miss registering for quality and coding programs 

The final education programs of the year are approaching! Don't miss these opportunities to learn about improving quality metrics, coding and reimbursement.

These complimentary webinars are open to The Physician Alliance members only. 

Tuesday, Nov. 8, 2022; 12-1pm**

Population Health & Quality webinar


Primary care and specialty care practices participating in the Physician Group Incentive Program (PGIP) through TPA can join this webinar to better understand:

  • quality metrics related to chronic conditions
  • updates related to BCBSM quality programs and/or initiatives
  • performance reporting and performance improvement

**This program will include a special presentation by BCBSM on patient experience of care.

TPA staff will lead this program to provide insight and answer questions. 

Wednesday, Dec. 28, 2022; 12:15-1pm

Lunch with the Coder: 2023 CPT coding updates


Get ready for the annual current procedural terminology (CPT) code set updates that take effect Jan. 1 by attending this informative webinar. Learn the latest updates to keep your practices’ coding accurate in 2023 including:

  • understand why codes have been updated
  • important new additions
  • support documentation needed
  • applying new codes

Affiliate Partner expands estate planning services

According to a recent Caring.com survey, “in 2022, simple procrastination remains the number one reason Americans don’t have a will, with 40 percent saying they haven’t gotten around to it.”

Planning for the future can start now. No matter your age, income or assets, estate planning can help protect your decisions for the future. Estates may include car, home, real estate, financial accounts, furniture, personal possessions and more. 

One of The Physician Alliance's Affiliate Partners, Rickard & Associates, expanded their estate planning services. Some examples include: 

  • Healthcare directives
  • Power of attorney (financial and medical)
  • Wills and trusts
  • Probate

TPA members receive premium services at preferred rates. Click here for more information on why you need an estate plan. Click here to see list of available legal services and to request a free estate planning consultation. 

The latest healthcare news

Parent Information Network backs CDC move to add COVID-19 vaccine to pediatric immunization schedule, MSMS

Hospitals plead with Congress to postpone looming Medicare pay cuts, Axios

Healthcare operating costs rising almost everywhere, report says, Becker's Hospital Review

Kids in the Midwest will get more blood screenings under EPA plan to deal with lead threat, NPR

With hospitalizations ticking up, flu season appears off to an early start, Stat

Ways you can save

Featured Affiliate Partner: PRINT & OFFICE SOLUTIONS: American Office Solutions provides office document technology, including printer/copiers, shredding services, mail solutions, HIPAA compliant document management/workflow software/cloud solution and more. TPA members receive various discounts on all services. 

Learn more about this partner.

Visit TPA's Website