Pay for Performance Initiative

Medicare Begins Pay-for-Performance
April 15, 2005

The New York Times on Friday looked at how Medicare for the first time has begun giving providers financial incentives to meet quality goals. More than 600,000 Medicare beneficiaries by the end of this year will be participating in pilot projects that give physicians and hospitals bonuses for improving medical care. Physicians will get bonuses for demonstrated improvements in care for patients with common chronic diseases such as congestive heart failure, coronary disease, diabetes and high blood pressure. The program involves 10 large groups covering approximately 200,000 patients, the Times reports. Medicare likely will pay $21 million in bonuses to hospitals during the three-year program.Medicare already has launched a similar pay-for-performance program involving 280 hospitals, and later this spring Medicare will publish on its Web site results on 34 quality measures for those hospitals, the Times reports. A third test project scheduled for later this year will deal with chronic-care management companies that help patients manage diabetes and other chronic illnesses (Kolata/Abelson, New York Times, 4/15).

As a medical provider, you can serve your patients, comply with current and upcoming mandated guidelines and generate the necessary “pay for performance” data relating to patient education and disease management, through the services of a certified health educator. These services are consistently reimbursed when using standard procedure codes designated for patient education.

You will provide greater service to your patients, increasing self-selected compliance which result in improved clinical and quality of life outcomes, and in addition generate additional income for practice overhead. The following is a excerpt from a Family Physicians Journal article, which discusses how simple and beneficial incorporating patient health education into your current billing practice is.


“Most practices already provide a number of billable services [such as patient education] but fail to capture those charges. Reporting [these services] can bring additional, easy revenue to your practice.”

— Quoted from the American Academy of Family Physicians Journal

By using established procedure coding designated for patient education services you can simply and appropriately integrate patient education into your current practice with no additional staff training or expense. This added benefit to your patients and practice is a “drop-in component” to your current billing procedures.

Since 1997 NIWH has provided, free of charge to physician and provider practices, hospital and clinics participating in NIWH Pilot Programs, this outstanding billing and coding manual.  To learn more about the NIWH Physician’s Billing Manual contact Paul Bergeron, MD, Director of NIWH Pilot Programs, NIWH Administrative Office – 888-354-HEAL (4325)

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