We understand that you may have questions about our medical services. Here are some common questions and answers to help you:
We are built by a team of passionate healthcare experts with deep expertise in the space.
A Business Associate Agreement (BAA) is a legal contract between a covered entity (e.g. a primary care practice) and a business associate (BA) that outlines how personal health information (PHI) will be protected. The BAA is required by the Health Insurance Portability and Accountability Act (HIPAA) to ensure that protected health information is protected when a covered entity uses a third party to perform services.
Yes. Once a BAA (Business Associate Agreement) is signed, we will either integrate into the EHR or we can use our own staff to read and write into the EHR.
Our solution is staffed by real people. You will always be able to call and talk to a real person.
We will charge a nominal fee per engaged member for which CMS will be billed; the large majority of the billable dollars will be retained by the practice. This model also minimizes any financial risk by only billing for patients who are receiving the billable service and always makes sure the service is profitable to the practice.
No. Since this is reimbursed by Medicare this will not add any additional cost to the practice – in fact we will generate additional revenue for the clinic.
We will move the needle on factors that impact HEDIS and Stars ratings including things like screenings (colonoscopy, mammography) prevention (annual wellness visits, flu shots) and disease specific measures (diabetic retinopathy screening, medication refill adherence).
As part of signing a BAA, we are committed to storing and handling sensitive health data in compliance with HIPAA regulations - access controls, auditability, encryption and other industry best practices. All PHI data will either live within your existing EHR or, if any data has to be transferred it will be stored in a HIPAA compliant manner – our solution is built by a team from Google Health that has built HIPAA compliant software.
The goal of our service is to serve the patient and provider to remove any blockers to allow them to get the care and services they need. Since we use real people there is no limit to what we can help with. However common tasks include things like scheduling followups, referral management, calling pharmacy, DME, obtaining medical records or care plans, sharing care plans or records with providers or caregivers, organizing rides, SDOH screening, getting patients connected to social services, as well chronic disease monitoring and coaching. The provider, office staff, or patient may ask for our assistance with respect to anything needed to improve the patient’s health. For any medical questions or after hours medical decision making – we will route the call to the office or answering service.
We will sign a Business Associate Agreement (BAA) when formalizing our relationship, after which we will be able to access the EMR. Our onboarding team would work with the provider to understand if there are any standard protocols they would like us to use for all their patients (e.g. BP, DM, care gaps, etc) and understand any other preferences. The process should not take more than 4 weeks. You will always have access to our team via a real number to call at any time to talk to a real person if there are any questions.
Both. We use human staff to communicate, inform, and answer patient and provider questions. Once our staff understands what the patient or provider need help with, we leverage software automation to execute on these tasks (e.g. call insurance, schedule appointments, check on meds / DME, etc). By using software for the backend tasks we are able to maintain a high touch service for communication with patients and providers.
This is not required. There are are a few options to introduce this service to patients (1) The office staff introduces the service to the patient as a Medicare benefit (e.g. “If you have any questions, or need any help, call this number – they help me do my job”) (2) Patients are provided a paperwork explaining the program and a consent form to opt in when they visit the clinic (3) the provider themselves introduces the tool as a concierge service the patient can use to get help with any logistical tasks surrounding their care.
No. We will not do any medical decision making or alteration of the care plan. We will have access to the EMR and the last clinic note – and will be able to remind the patient about their most recent care plan. However, any medical questions or decision making will be immediately forwarded to the provider’s office to determine the best medical course of action.
The service is offered as an extension of your primary care practice. We will sign a BAA with your organization, after which we will be able to have our staff review the patient chart, therefore we will be able to answer questions that are documented in your chart, and those that are not explicitly answered we will immediately transfer to your office staff. We use trained medical staff to ensure a high touch experience and ensure the patient is not stuck in a confusing phone tree.
No. We will look for an updated care plan (default is clinician’s last Assessment and Plan) after each visit, and then assist the patient in carrying out the goals stated in the provider's plan. There is no extra work for the provider. If there are any additional tasks the provider would like our help with, they can either document this or explicitly communicate this to our team through a dedicated number where they will always get a live person. We will handle all documentation needed for billing. We will document every month the availability of Advanced Primary Care to allow for billing for these services.
There are 13 requirements defined by CMS – most are centered around having a care plan, helping patients coordinate care, and closing care gaps. MedRock AI’s goal is to delight the user – we will perform a superset of these services, helping the patient with whatever blockers they face in following their care plan and accessing care, meds, or services.
This is not a loophole. CMS is attempting to put money behind services that improve patient outcomes in line with its stated goal of moving all patients to value based contracts by 2030. CMS recognizes the importance of primary care in improving patient outcomes and is trying to incentivize the move back to traditional primary care where a PCP coordinates and quarterbacks patient care. Previous care coordination codes have less than 4% adoption and CMS has therefore removed the time requirement of these old codes to incentivize providers to bill and provide these services.
Yes. In addition to reading the physician fee schedule, our team has spoken with several lawyers to check our interpretation. Law firms have also published guidance on these codes including.
We have an online calculator to understand how much revenue can be generated through different scenarios. A single provider can stand to gain up to $600k+ in additional revenue per year (1250 Medicare patients; 80% have 2 or more chronic conditions; patient billed at $600 / yr). If the provider also has Qualified Medicare Beneficiaries (QMBs) (nationally 13% of medicare patients are QMBs) this could drive up to $700k / year in additional revenue (1250 Medicare patients, 70% traditional Medicare @$600/yr and 10% QMBs @ $1320 / yr), For an average PCP generating 1.3 - 1.5M in revenue this is up to an additional 50% in revenue gain.
No. While the new APCM codes are inspired by previous codes, the huge change is CMS is no longer placing any minimum time requirements on these codes – which means that as long as the practice is providing advanced coordinated care, you can get reimbursed. MedRock AI's unique value proposition is using back end software automation to efficiently deliver solutions, even while maintaining a high touch patient and provider experience. Since the codes no longer have a time component, MedRock AI's ability to more efficiently deliver coordinated care means greater profits for the practice.
We will provide all the necessary documentation in the chart every month. The practice only needs to then submit for reimbursement to CMS (G0556, G0557, G0558) and payments will be made directly to your practice by CMS.
CMS is introducing a new set of codes called Advanced Primary Care Management (APCM). CMS pays $50/patient/month for medicare patients that have 2 or more chronic conditions and $110/patient/month for Qualified Medicare Beneficiaries (QMBs). CMS has stated that practices can bill monthly for the availability of these services, which means practices can expect to bill between $600-$1320 / patient / year. These codes essentially pay for PCPs to help coordinate a patient's care.
