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PCSP Policies & Procedures Guidebook - eBook

Ebook -

Compliance Regulations

Policies & Procedures

SKU: E9037


ISBN#: 978-1-56829-528-2

A step-by-step guide to applying for and obtaining recognition as a patient-centered practice through the NCQA’s Patient-Centered Specialty Practice (PCSP) program.

As the landscape of healthcare migrates from one focused on disparate, disconnected care to that which features coordinated care across the spectrum of providers and facilities, specialists play a vital role in ensuring the success of healthcare today.

The goal of the care delivery system is simple: to obtain the best possible outcomes for patients by providing comprehensive, continuous and efficient quality medical care to patients, coordinated across all settings.

The goal of a specialty practice participating in this new system is to fully participate in a system that is:

  • Subject to a care planning process and the use of evidence-based medicine and other tools (e.g., clinical decision support, performance measurement, and information technology);
  • Coordinated or integrated across all types of providers (e.g., primary care providers, specialists, mental health, home health) and locations (e.g., hospitals, home health agencies, nursing homes);
  • Informed by the patient’s participation in decisions; and
  • Enhanced through processes (e.g., open scheduling and expanded visit hours) that assure adequate access and the use of technology to provide optimal communication among patients, their physicians, and other caregivers.

The PCSP Policies & Procedures Guidebook can help your organization in applying for and obtaining recognition as a patient-centered practice through the NCQA’s Patient-Centered Specialty Practice program. A step-by-step guide, it assists your coordination of that journey through providing a practice infrastructure in the form of concrete policies and procedures aligned with the NCQA’s 2016 PCSP standards.

While intended to benefit all specialty practices that seek to become an acknowledged and successful a patient-centered practice, the guidebook adheres to the application of the NCQA’s current PCSP standards.

This guidebook provides an effective platform for compliance with 'Improvement Activities,' the new reporting category for the Merit-based Incentive Payment System (MIPS). Investing in the PCSP Policies and Procedures Guidebook facilitates your practice's successful participation in the government's new reporting program, which launched on January 1, 2017. By adopting just one of the multitude of policies in the guidebook in 2017, you can eliminate the penalty of 4%, which translates into more than $3,000 for most practices!*

*Per the Centers for Medicare & Medicaid Services (CMS), “Clinicians can choose to report one measure in the quality performance category; one activity in the improvement activities performance category; or report the required measures of the advancing care information performance category and avoid a negative MIPS payment adjustment. Alternatively, if MIPS eligible clinicians choose to not report even one measure or activity, they will receive the full negative 4 percent adjustment.” Source: CMS QPP Executive Summary, October 14, 2016. The $3,000 is based on an assumed revenue for the physician of $300,000 with 25% of his/her payer mix in Medicare. “Revenue” is assumed to be a proxy for total allowed charges, to which the MIPS penalty will be applied.

 Elizabeth W. Woodcock

Elizabeth W. Woodcock, MBA, FACMPE, CPC

Woodcock is a professional speaker, author and trainer specializing in medical practice management. Woodcock has focused on medical practice operations and revenue cycle management for more than 15 years. Combining innovation and analysis to teach practice operations, she has delivered presentations at regional and national conferences to more than 150,000 physicians and managers. In addition to her popular e-mail newsletters, she has authored several best-selling practice management manuals and textbooks and published dozens of articles in national healthcare management journals. Woodcock is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a bachelor of arts degree from Duke University, she completed a master of business administration in healthcare management from the Wharton School of Business of the University of Pennsylvania.

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