Medical Condition Assessment Incentive Program

Medical Condition Assessment Incentive Program

Medical Condition Assessment Incentive Program

Medical Condition Assessment Incentive Program

Medical Condition Assessment Incentive Program

Medical Condition Assessment Incentive Program

The Medical Condition Assessment Incentive Program (MCAIP) aligns with the Medicare Advantage Primary Care Physician Incentive (MA-PCPi) program. MCAIP offers 3 bonus opportunities when you assess suspect medical conditions for your patients.

2022 incentive opportunities

Medical Condition Assessment Incentive Bonus

Get rewarded when you assess suspect medical conditions for Medicare Advantage members.

Fully Assessed MCAIP Customer Bonus

Earn an additional bonus for each fully assessed member.

Medical Condition Assessment Superior Bonus

Earn an additional bonus when you achieve a 4.00 Average Star Rating and evaluate at least 65% of identified suspect medical conditions.

Eligibility

We invite eligible primary care physicians to enroll in the program annually. Your invitation to participate is sent by mail and outlines the current year’s bonus opportunities and criteria.


Opportunity #1: Medical Condition Assessment Incentive Bonus

Your practice can earn a quarterly bonus when you assess eligible UnitedHealthcare® Medicare Advantage members for suspected medical conditions. Eligible members and medical conditions are identified in the Patient Care Opportunity Report (PCOR) and Practice Assist. Practice Assist is also used to document the results of your assessment.

Here’s how it works:

  • Earn $20 for each suspect medical condition that you’ve assessed and diagnosed or assessed but were unable to diagnose
  • If a suspect medical condition is diagnosed, include the appropriate ICD-10 code(s) when you submit the claim
  • If you assess but are unable to diagnose the condition, report in Practice Assist that you’re unable to diagnose the suspect condition at the present time. Be sure to include the date of the assessment.

Opportunity #2: Fully Assessed MCAIP Customer Bonus

Your practice may earn an additional $10 quarterly bonus for each fully assessed member’s suspect medical condition. Fully assessed means the member has been assessed for each suspect condition. The bonus is multiplied by the total number of suspect medical conditions that you assessed for the member during the quarter.

Bonus calculation

Member Number of suspect conditions Assessed and diagnosed Assessed and unable to diagnose Not assessed Fully assessed member (Y/N)? Fully assessed customer bonus
John Doe 7 5 1 1 N 0
Joe Smith 8 7 1 0 Y $80
Dana Turner 10 8 2 0 Y $100
Total 25 20 4 1   $180

Opportunity #3: Medical Condition Assessment Superior Bonus

Earn an additional annual bonus by:

  • Achieving an Average Star Rating of at least 4.00 within the MA-PCPi program, and
  • Assessing at least 65% of identified suspect medical conditions

Performance level bonus opportunities

Percentage of suspect conditions assessed Medical condition assessment superior bonus
95% and above $125.00 PMPY
85% - 94% $100.00 PMPY
80% - 84% $75.00 PMPY
75% - 79% $50.00 PMPY
65% - 74% $25.00 PMPY
64% and below 0

Track your progress

You can use Practice Assist to monitor your progress toward these incentive opportunities. It’s available on the UnitedHealthcare Provider Portal in the Clinical & Pharmacy section. To access the portal, click Sign In in the upper right corner of this page, then log in with your One Healthcare ID and password. If you don’t have an ID and password, you can register for one. 

Payout dates

Quarterly bonus opportunities
Dates of service Payment dates
Jan. 1 – March 31 July 31, 2022
April 1 – June 30 Oct. 31, 2022
July 1 – Sept. 30 Jan. 31, 2023
Oct. 1 – Dec. 31 May 31, 2023
To help ensure the provider is reimbursed as outlined, UnitedHealthcare will review the provider's claims and data submissions for the previous quarter(s) and make additional payments, if applicable.
Annual bonus opportunity
Dates of service Payment date
Jan. 1 – Dec. 31, 2022 May 31, 2023

Tips for success

  • Prioritize which members should come in for a visit using the Patient Care Opportunity Report (PCOR) or Practice Assist
    • PCOR shows which members are due for preventive care including screenings, annual care visits or other exams. Review the self-paced training for more details and instructions.
  • Before the member’s appointment, highlight suspect medical conditions in each patient’s medical record
  • If you’re unable to diagnose a suspect medical condition at the care visit, report the information in Practice Assist with a note that confirms the condition was assessed but unable to be diagnosed and the date of service

Resources

Questions?
Contact your UnitedHealthcare representative if you have questions or need more information.