Medical Billing Outsourcing

Patient Relationship Categories

Along with the proposed rule that CMS recently released, the agency will attempt to garner comments on several other documents related to MACRA implementation. One of these requests concerns patient relationship categories, while the other deals with interoperability.

The layout of MACRA requires that CMS devise categories for patient relationships with physicians, ranging over an episode of care, and also the codes required to document these relationships. These codes are meant to link patients to certain providers in order to identify which physician will be responsible for a given set of services, as well as attributing any financial risks or rewards, which are connected to that patient’s care.

With MACRA shifting patient reimbursements from FFS and towards more collaborative methods of care provision, the situation calls for a system that allows documenting things like the role a provider will play in a care team, or whether a service is part of a current episode of care, or if it is a new episode of care.

CMS has proposed five categories, which span three broad relationship types. Physician specialties may enter one category than another, or even into all three. The relationships CMS suggests adopting are:

  • Continuing Care Relationships: This includes clinicians of two types. The first is where the clinician is the ongoing primary health care provider for a patient receiving chronic and acute care. The other, if the clinician is providing specialized chronic care as part of the patient’s treatment.
    Medical Billing Healthpac

    MACRA Implementation

  • Acute Care Relationships: This includes clinicians who take over coordination of the patient’s overall health while there is a current acute episode. Another type of physicians falling into this category is someone serving as a consultant at the time of an acute episode.
  • Acute Care or Continuing Care Relationship: These are clinicians who provide care to a patient, but only as ordered by another clinician.

Additionally, the agency is pitching a category specific to non-patient facing clinicians, and wants to get feedback including comments on how, in such cases, situations can be distinguished among.