variety of sources, such as provider
surveys, Alliance committees like
the Physician Advisory Group, a
comprehensive evaluation of the
CBI program and input from
the Alliance Board. Based on this
feedback, we’ve adjusted the 2014
CBI program with the following
CBI goals in mind: 1) improve
quality, 2) improve access,
3) improve provider and member
satisfaction, and 4) improve care
delivery to our members.
So, what can you expect from
the new 2014 CBI Program?
●●
Providers must submit all
fee-for-
service
(FFS) incentive forms within
21 business days
from the date of
service (formerly within 30 days at
the close of each quarter).
●●
ICD-10 crosswalk
—Effective
10/01/14, ICD-10 codes
must be used. For claims
with dates of services
from 10/01/14 to
12/31/14 and for
the purpose of
calculating the
CBI incentive
payments, the
Alliance will
crosswalk
any ICD-10
data to the
appropriate
ICD-9 code as set
forth by the 2014 Center
for Medicare and Medicaid
Services (CMS) General
Equivalence Mappings.
●●
New
FFS measure—
Physician Orders for Life
Sustaining Treatment
(POLST): This
incentive is designed to
ensure that conversations
on end-of-life planning
occur with seriously ill
patients. This allows them
to choose the treatments
2014 CBI Updates
they want and ensure their wishes
are honored by medical providers.
Providers are given an incentive of
$100 for Alliance receipt of the first
completed POLST form submitted
per PCP’s linked Medi-Cal Seniors
and Persons with Disabilities (SPD)
members.
●●
Retired
measure—Primary Care
Visits: This was retired as all
practices are now FFS and the need
for office visits varies.
●●
Reallocation of points
—EDI
Claims submissions to electronic
referrals to encourage referrals using
the Alliance Portal.
●●
Revised
measure—Generic
Prescription: Methodology was
revised to align with the Integrated
Healthcare Association.
●●
Revised
measure—Rate of
Ambulatory Care Sensitive
Admissions: Points will be
allocated by deciles to reduce the
wide swings in scoring for small
practices or frequent admissions
by complex patients. This is the
same methodology used for Rate of
Preventable ED visits.
●●
In effect
—Rate of Readmission
within 90 days from inpatient
discharge: Incentive payments will
now be awarded in 2014 and points
will be allocated by deciles.
●●
Improved
measures—Alliance
forms for the FFS incentive:
Asthma Action Plans and
Medication Management Form.
Note: Providers may submit their
own form for approval.
For additional details related
to the CBI program, please
contact your Provider Services
Representative. Updated 2014
CBI information will be available
via the provider workshops, the
Alliance website provider pages
and the January 1, 2014 Provider
Manual—all available in the
coming months.
B
eginning January 1, 2014,
updates to the Care Based
Incentive (CBI) program will
be in effect. The 2014 CBI program
incorporates feedback from a
PAGE
4
of
12
PROVIDER NEWS
