Humana Medicate Advantage P4P Update
Humana finally settled up for nearly all of 2013 – the initial period of the new pay for performance contract.
The good news is all practices in that Humana contract have earned a bonus payment. Each practice that
helped us meet quality metrics and achieved cost savings by having less than a 85% medical loss ratio on
their Humana attributed patients received their pro rata share of those bonuses.
The practice shares of the cost savings were adjusted for patient severity using the actual codes each practice
provided to Humana in billing for patient encounters.
We would have earned considerably higher bonuses if all the appropriate diagnostic codes had been provided.
We continue to report our patients having less complexity then the average Medicare patient when TN
ranks among the highest on health conditions. Accordingly HPI will provide more assistance including two
medical coders to help, plus training for practice staff and member physicians in 2015.
We congratulate all our participating members on the bonus they earned in 2013 and we are employing additional
resources to help our practices be even more successful.
In our last issue, we introduced Victoria Butler, who comes to us to coordinate our P4P projects, manage our
contract performance and provide consulting and support services for our practices participating in the Qualuable
We would like to introduce Kristie Castle, our newest staff member. Kristie most recently held the position of coding specialist for WMA Bristol, Kingsport and Johnson City pulmonary groups. Kristie comes to HPI with over 20 years’ experience in healthcare and multiple specialty coding certifications. She has experience in pulmonary, gastroenterology, neurosurgery and other sub-specialties like OB GYN and infectious disease.
Kristie will be working with our incentive programs collecting data, providing staff assistance and coding education. HPI is also working to implement a transition in care program which Kristie will be managing. She has bee a Certified Professional Coder since 2007 and is currently enrolled in the nursing program through Mountain Empire Community College.
If you need coding assistance, please contact Kristie at 423-392-1920.