Increase in Value-Based Reimbursement for PCMH-Designated Practices Announced

Medical Billing

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Effective Sept. 1, 2019, through Aug. 31, 2020, value-based reimbursement for the Patient-Centered Medical Home designation will increase from 110% to 115%.

The temporary change recognizes that PCMH value-based reimbursement has remained at the same level for 10 years, but the expectations have become more rigorous over time and continue to evolve.

As part of the continued evolution of the program, we encourage PCMH practices to collaborate with their physician organizations to:

  • Adopt more advanced PCMH capabilities
  • Use care managers or care teams and the health information exchange to improve care coordination

Value-based reimbursement for PCMH designation will return to 110%, effective Sept. 1, 2020. The additional 5% value-based reimbursement will be reallocated from PCMH to the Provider-Delivered Care Management program for primary care physicians.

We’ll be communicating about these changes in future issues of The Record.

If you have any questions about these changes, contact your PGIP physician organization.


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