Comprehensive Primary Care Plus

Question: What is the Status of the New CMS Primary Care Payment Initiative?

Answer: Last summer, the Centers for Medicare & Medicaid Services (“CMS”) announced a new initiative intended to improve payment for primary care. The program, called “Comprehensive Primary Care Plus” (“CPC+”), was begun in 14 regions, including 11 whole states. In this area, it included all of New Jersey, the North Hudson Valley in New York and the Greater Philadelphia area in Pennsylvania. These areas were selected on the basis of density and interest shown by providers and payers. Under CPC+, providers are to be paid a monthly fee for primary care visits. The initiative is intended to improve outcomes and lower costs. The initiative has two tracks – under track one, providers receive a monthly fee for specific services, in addition to fee-for-service payments. Under track two, providers will receive an upfront monthly care management fee and reduced fee for service payments. This is intended to allow providers to offer care outside of traditional face to face encounters. Depending upon the volume of patients, providers could potentially earn an additional $100,000 to $250,000 per year under the model. The model was supposed to launch in up to 20 regions, but CMS saw less interest than was expected, and this pattern has held when the program was recently expanded. CMS has just recently announced four new markets for the initiative, to begin in January, 2018. The new markets to be added include the Greater Buffalo Region in New York, encompassing Erie and Niagara, as well as Louisiana, Nebraska and North Dakota. No reasons have been given for the apparent lack of interest in this initiative, which resulted in it being rolled out in fewer new markets than anticipated.

Weekly Charting Tip: What can be the cause of a False Claim Act being filed against you by the Federal Government?             

  • Up-coding procedures
  • Unbundling procedures
  • Filing multiple claims for the same procedure
  • Billing for medically unnecessary procedures
  • Violating the Anti-Kickback Statute
  • Putting down the incorrect place where the service was rendered
  • Putting down the incorrect health care provider that claimed to have rendered the services
Oh yes, and a disgruntled former employee to call the government so that he or she can claim a piece of the action!


Until next week, Larry Kobak, Partner, Kern Augustine, P.C.

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