The PULSE of The Physician Alliance
Friday, Dec. 20, 2019
Additional PDCM billing codes available to unlicensed personnel
Blue Cross Blue Shield of Michigan recently announced an increase in billing codes that medical assistants and community health workers can bill in the Provider Delivered Care Management (PDCM) program in 2020.

These unlicensed personnel can currently bill three PDCM codes: 98966m 99487, and 99489 . Two additional codes - 98967 and 98968 – are available Jan. 1, 2020 , enabling these practice staff to bill five of the 12 PDCM codes. These codes will count in the analysis of PDCM value-based reimbursement (VBR), and the PDCM billing guidelines will be updated in January 2020.

As a reminder, all care team members must complete appropriate trainings commensurate with their role in the practice within 6 months of the date they first start billing the PDCM codes.

This change will provide more opportunities for practices to meet the required 4% engagement rate (in calendar year 2020) to achieve the 2021 PDCM Population Management VBR. Even more reason to have additional members of the care team trained to provide care management services!

Practices interested in having a medical assistant, community health worker, or additional members of the care team trained to deliver care management services and improve potential for additional reimbursement should contact Sharon Kraydich at or 586 498 3558.
TPA joins Blue Cross and others in new reimbursement model
Blue Cross Blue Shield of Michigan announced last week Blueprint for Affordability, a new value-based reimbursement model with shared risk among partners.The Physician Alliance is one of the first partners to join this model, along with Ascension Michigan, Henry Ford Health System, Oakland Southfield Physicians, Michigan Medicine, Trinity Health and United Physicians.

The new payment model enables organizations to work together to help patients get healthy and stay healthy, maintain high quality of care standards and better manage the overall cost of care. The Blueprint model builds upon the Value Partnerships program, which has been helping to improve health care quality and reduce costs since 2005. Value Partnerships has helped in the transition from the fee-for-service model to a fee-for-value approach through programs like the Physician Group Incentive Program and Patient-Centered Medical Home program. These programs have changed the way care is delivered in Michigan and Blueprint will continue that journey.

Blueprint will include BC commercial PPO and Medicare Advantage PPO, and begins in January 2020 for participating organizations. Learn more about Blueprint for Affordability. Read a FAQ about TPA's participation.
The Physician Alliance and Ascension Southeast Michigan participated in BCBSM's Blueprint for Affordability announcement. TPA joins Blueprint in partnership with Ascension Southeast Michigan as the contract is held by Partners in Care, the managed care entity co-owned by TPA and Ascension Southeast Michigan. Pictured (L-R): Dr. Dennis Ramus, board chair, TPA; Michael Madden, president/CEO, TPA; Dr. Kenneth Berkovitz, president, Ascension Michigan/Ascension Medical Group. Madden and Berkovitz also serve as co-senior executives of Partners in Care.
Seminar helps practices prepare for new CPT codes
CPT Coding Updates seminar
Madison Heights, MI
Thursday, January 30, 2020
8-9 am

With almost 400 code changes in the 2020 CPT code set, including 248 new codes, 71 deletions and 75 revisions, it's critical for practices to stay in the loop on appropriate coding.
Changes to the Physician Fee Schedule are aimed at reducing burden, recognizing clinicians for time spent caring for patients, removing unnecessary measures, and making it easier for clinicians to be on the path towards value-based care. Attend this informative coding seminar to:
  • Learn about updates to the CMS 2020 Final Rules for Physician Fee Schedule
  • Gain a better understanding of the complexities of medical decision making
  • Learn how documentation may be impacted

Click here for more information and to register - limited seating !
Avoiding large losses in your portfolio
Risk is a factor in any investment decision. Your tolerance for risk is something that you will want to consider when you make investment decisions. Your risk tolerance is balanced against your time horizon, meaning the time between now and your anticipated retirement date.
While it's not possible to completely avoid a loss, you can take steps to manage risk when investing. This is where conversations about your risk tolerance are critical.
  • Would you rather have $500 right now or 50% chance at $2,000? Many people choose the $2,000 and rightfully so. With a 50/50 chance, a decision tree shows the $2,000 answer carries a potential value of $1,000.
  •  Let's add a few zeros to see if that changes your perspective. Would you rather have $50,000 right now or 50% chance at $200,000? The decision tree says the opportunity to win $200,000 has the highest potential value. But in reality, many people second-guess that decision because $50,000 is a lot of money.
Remember, there is no correct answer to the questions. They simply help you better understand the concept of risk.
Investment risk can be managed, but it can't be eliminated entirely. All investments carry some level of risk. And in general, the greater the risk an investment carries, the higher its potential return.
Risk happens, but don't let it get in the way of your dreams. Ultimately, these concerns should only serve to inform you and the questions that you ask the financial professional you are working with. The conversation should include questions about the risks for each strategy presented as well as questions from your professional about the retirement you want and the aspirations you hope to realize.

Submitted by : Kaled Khaznehkatbi, VantagePointe Financial Group. A TPA Affiliate Partner , VantagePointe offers comprehensive financial planning with reduced fee services to TPA members.
News You Can Use
Featured Affiliate Partner
Ambs Call Center provides medical answering services, including answering service, free web on-call app, secure messaging, online access to calls. TPA members receive first month free and additional discount on plans.

Learn more about these services.
The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians. - (586) 498-3555