Patient Attribution Methodology
The methodology that was used selects a provider as the member’s attributed provider when that provider has the greatest number of E&M visits during the 12-month period preceding the end of the measurement period. The member must have at least one preventive care visit or two E&M visits with a physician in the most recent 12 months of the measurement period to be eligible for attribution using the Imputed PCP methodology.
The E&M Codes have been constrained to focus on E&M Visits rendered in an outpatient or Nursing Home Care setting to support the request to conduct attribution based upon outpatient visits only. The E&M code list now excludes inpatient hospital codes, but includes the following:
• Enrollment
• Imputed
The E&M Codes have been constrained to focus on E&M Visits rendered in an outpatient or Nursing Home Care setting to support the request to conduct attribution based upon outpatient visits only. The E&M code list now excludes inpatient hospital codes, but includes the following:
1) Office Visits
2) Non-Inpatient Consultations
3) Home Visits
4) Nursing Home Care
The following is the ranking hierarchy to be used in selecting the single attributed primary care provider for each patient:2) Non-Inpatient Consultations
3) Home Visits
4) Nursing Home Care
• Enrollment
1) Enrollment PCP submitted by Health Plan as of the last day of the reporting period.
2) If the Enrollment PCP meets the criteria, then the following tie-breaker logic is used:
• The PCP on the eligibility span with the latest eligibility end date submitted by the plan
• Greatest number of E&M or Preventive visits
• Most recent E&M or Preventive visits visit date
• Greatest number of E&M or Preventive visits
• Most recent E&M or Preventive visits visit date
• Imputed
Greatest number of E&M or Preventive visits. If more than one Enrollment PCP meets the criteria, then the most recent service date is used.