Changes have been made to Akamai PM to track and monitor the implications of HMSA’s new “Payment Transformation” initiative for PCPs.
Akamai Practice Management was not provided in depth information ahead of the implementation date about how specific payment transactions would be reported. Furthermore, HMSA has clearly indicated that this initial “pilot program” may be subtly refined prior to the full‐scale roll‐out of the program, scheduled for January 1, 2017.
Consequently, our initial Payment Transformation enhancements should be viewed as a “version 1.0” approach to how Akamai PM will handle this program, and others like it, in the future.
In order to effectively monitor this program, several types of transactions need to be recorded by users, some of which are new:
The standard Contractual Write‐Offs and Allowed Amounts that would have resulted if the claim had been adjudicated under a fee for service arrangement.
A phantom ‘paid amount’ that is not actually received, but needs to be retained in Akamai PM. This is necessary since HMSA explicit instructions have been to bill patients and secondary payers as if the practice has been paid fee‐for‐service. (There is more about potential issues associated with these directions in a discussion which follows these notes).
Per‐Member‐Per‐Month (PMPM) receipts for each HMSA line of business. This is what the practice is receiving in lieu of payments for services provided.
Capitation Withhold to determine how much has been forgone that would have otherwise have been paid under a fee for service arrangement