2020 Changes for Vatica/Excellus Risk Coding Program

2020 Changes for Vatica/Excellus Risk Coding Program

January 29th, 2020 | Network News

The Vatica/Excellus Medicare Advantage program has been returning valuable incentives to AHP practices since 2018, and some upcoming modifications to the program will make it even easier for practices to participate.  Vatica Health’s Well365Plus Solution is a cloud-based tool used to ensure more accurate coding of chronic conditions, and it is available at no cost to Excellus-participating physicians. AHP is encouraging primary care practices with significant Excellus Medicare Advantage attribution to consider implementing the Vatica program, since more accurate coding may position AHP for additional gain sharing under its Excellus Medicare Advantage contract.

Participation in the program has significant financial benefits for practices: for each eligible patient for whom all gaps are closed using the Vatica tool, the provider will earn $175. If completed in conjunction with an annual physical and wellness visit for a Medicare Advantage member, for example, total reimbursement averages around $350 per visit.  The program also has a volume-based incentive: providers who achieve a 65% rate of Vatica encounters for eligible members will receive an additional $50 cash incentive for each Vatica encounter completed.

If you are currently participating with Vatica, there are several changes to the program for 2020, including the method by which claims will be paid: rather than requiring use of the CG modifier and receiving the incentive payment on the Excellus remit, providers will simply receive their incentive dollars via monthly payment from Vatica Health. Other changes include the Vatica program expanding to patients covered by commercial products purchased on the NYS Health Plan Marketplace in addition to eligible Medicare Advantage members. Lastly, the Vatica tool can be used for many other visit types, not just the Annual Wellness Visit.

Interested in enrollment or scheduling a Vatica demo? Please contact Physician Relations Liaison Kevin Kelley.  Already enrolled? Expect full details from your Excellus Provider Representative soon.