Continuity of Care Bonus Program
Date: 06/24/21
Continuity of Care Bonus Program (PDF)
Quality Addendum
Program Starts Jan. 2021
For Dates of Service Jan. 1, 2021 - Dec. 31, 2021
Western Sky Community Care understands that the provider-member relationship is a key component in ensuring superior health / care and the satisfaction of our members. Because Western Sky Community Care recognizes these important partnerships, we are pleased to offer the 2021 Continuity of Care (CoC) Quality Bonus Program, which rewards PCPs for improving quality and closing gaps in care.
New in 2021, the CoC program includes an incentive enhancement to better align payment with quality. Providers can now earn incentives at multiple levels based upon Medicare Star Rating achievement for each measure. We believe that our new incentive structure will better support you and your healthcare team in caring for our members.
Each measure will be calculated and rewarded individually. Star Rating is determined by comparing a CoC provider’s compliance percentage for a given program measure to established benchmarks.
Quality Bonus Instructions
- The measurement period is Jan. 1, 2021 to Dec. 31, 2021. must receive all claims/encounters by Jan. 31, 2022.
- Schedule and conduct an exam with the eligible member using HEDIS® reports as guides to close care gaps and update diagnoses. Note: Additional Star measures may become applicable to eligible members as claims and data are received throughout 2021.
- Provide appropriate medications to your members and encourage them to fill their prescriptions; consider 90-day supplies for members stable on therapy.
- Upon completion of the examination, document care and diagnosis in the patient’s medical record and submit the claim/ encounter containing all relevant ICD-10, CPT and/or CPT II codes by Jan. 31, 2022.
Payment Timeline
Payments will begin after processing claims/encounters for the first quarter of 2021. Payments will continue through 2022.
Additional Conditions
Only one Quality Bonus Payment will be made for a specific HEDIS and Medication Adherence member -measure combination.
Definitions
Eligible Member is a member who meets the age, sex, and/or disease-specific criteria, and the enrollment and other technical criteria, set forth in the HEDIS Technical Specifications or the most recent CMS Medicare Part C&D Star Rating Technical Notes document for the Program Measures.
CoC Provider means a primary care physician (PCP), vendor or independent practice association (IPA) who has a contract with Allwell from SilverSummit and receives this Program Information Guide.
HEDIS means Healthcare Effectiveness Data and Information Set. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
HEDIS Technical Specifications means the HEDIS 2021, Technical Specifications as published by the National Committee for Quality Assurance (NCQA) or any applicable successor specifications.
Medication Adherence Measures are the three Medication Adherence Measures published in the most recent CMS Medicare Part C&D Star Rating Technical Notes document:
- Medication Adherence – Diabetes Medications
- Medication Adherence – Blood Pressure Medications
- Medication Adherence – Statins
Program Measures are the HEDIS and Medication Adherence Measures that are included in the bonus amounts table. Program Measures are defined according to the HEDIS Technical Specifications or the most recent CMS Medicare Part C&D Star Rating Technical Notes document.
Thank you for being our partner in our members’ care.
Important Contact Information
If you have questions about CoC Program, please contact your Provider Relations representative or Quality Field representative.