Skip to main content

Q&A: Reimbursement Under PCF Model

Analysis  |  By Revenue Cycle Advisor  
   October 12, 2020

The PCF model will reimburse participants through a simple payment structure.

A version of this article was first published October 12, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: How will CMS reimbursement providers in the Primary Care First (PCF) model?

A: The PCF model will reimburse participants through a simple payment structure which has a payment mechanism that allows for clinical driven care, provides a population-based payment along with the primary care flat visit fee, and includes a performance-based adjustment. The adjustment can be a double-edged sword, as it provides an upside of up to 50% of revenue as well as a small downside of a 10% revenue reduction, which functions as an incentive to reduce costs and improve quality. The performance adjustment will be assessed and paid on a quarterly basis.

For more information, see "Note from the instructor: New demonstration model tests impact of advanced primary care on total cost of care," by Yvette M. DeVay, MHA, CPC, CPMA, CIC.

Revenue Cycle Advisor combines all of HCPro's Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly. Learn more.

Get the latest on healthcare leadership in your inbox.