Hello. I work for a commercial health insurance plan that is reviewing how we pay quality care incentives to our providers. Currently, our providers bill us with an "unused" HCPCS code but this will not longer pass audits in the future.

I’m now on a fact-finding mission – if your office receives payments from an insurer (including state Medicaid) for incentive programs (quality of care metrics), how do you bill these payments? What codes do you use? Do you submit it on a "normal" claim for a member or is it billed separately on its own claim? If it is billed separately, how do you report quality metrics to the insurer to make sure your patients are getting counted correctly?

Thank you for your help!