These frequently asked questions (FAQs) were developed to answer questions about the Independence Blue Cross (Independence) Nephrology Pay for Value (NeP4V) program. This program is designed to continually improve the quality of medical care and service provided to Commercial and Medicare Advantage members with late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD).
Note: This document will be updated as additional information becomes available.
1. Am I eligible for the NeP4V program?
To be eligible, groups must have a specialty type of nephrology. Please see the NeP4V program prerequisites in the program manual to determine eligibility.
2. How many attributed members do I need to be eligible for the NeP4V program?
Groups must have ten or more Commercial HMO/POS/EPO/PPO members and/or Medicare Advantage HMO/POS/PPO members during the measurement year who have been diagnosed with CKD (stages 4 and 5) or ESRD to be eligible for participation and payment in the program. These members must be attributed to the group. Please refer to the NeP4V program manual for additional details.
3. How is member attribution determined?
To be attributed, members must be 18 years or older and have had at least two nephrologist visits, excluding the inpatient hospital setting, with evaluation and management (E&M) within a 12-month period. In the case of a tie, the member is attributed to the provider with the most recent visit.
4. Will I be measured and paid at the group level or the IDS level?
If your group has only one practice, you will be measured and scored at the group level by the tax ID number (TIN). If your group is part of an Integrated Delivery System (IDS), you will be measured and scored at the IDS level.
5. What is considered to be an 'optimal start' for members on dialysis?
Regardless of the type of dialysis access (central venous catheter [CVC], peritoneal dialysis [PD] catheter, arteriovenous [AV] fistula, or AV graft) an 'optimal start' is a planned dialysis start initiated in the home or outpatient setting.
6. As a program participant, when will I receive incentive payments?
NeP4V program payments will be reimbursed in August following the measurement year, with the exception of the 'transplants per year' kidney care measure. For example, for measurement year 2022, you will receive incentive payments in August 2023. Please note that this date is a target and may vary depending on availability of data and other factors. Incentive payments will be reimbursed on both Commercial and Medicare Advantage membership in one program payment on the applicable payment cycle.
7. When will I receive incentive payments for the 'transplants per year' kidney care measure and how is a successful transplant defined?
The 'transplants per year' incentives will be paid to the attributed nephrologist in August two years following the measurement year in order to ensure that the transplant is successful. For example, a transplant performed in 2021 may be eligible for payment in August 2023. A successful transplant is when the member is dialysis free for the last six months of the post-transplant year.
8. Which of my members are eligible for the NeP4V program?
You can access PEAR Analytics & Reporting (formerly IndexProTM), the group reporting tool available on the Provider Engagement, Analytics & Reporting (PEAR) portal to generate a list of your attributed members. For more specifics, please see the NeP4V program prerequisites in the program manual to determine member eligibility for the program.
9. How do I enroll in and/or access the PEAR portal to view my NeP4V reports?
For more information, please see the dedicated PEAR portal page on our website.
10. Are the quarterly scorecards cumulative?
No, Independence provided scorecards as snapshots of performance review. You will be provided an end-of-year scorecard that is based on your calendar year performance.
11. Where do I find copies of scorecards and informational reporting?
Scorecards and informational reporting can be found in PEAR AR under Published Reports in the Output Manager section, located at the top of the page. These reports can be printed and/or downloaded to keep for your records. A notification will appear in PEAR AR when reports are available. Please see page 7 in the program manual.
12. How are ER utilization & IP utilization measured and is it only for CKD/ESRD?
In-patient utilization and ER utilization are measured by the total amount of attributed members with CKD or ESRD. Utilization is not limited to CKD/ESRD-related events but includes all health events.
Learn more
Please refer to the value-based programs webpage for updates to the NeP4V program and access to the program manual. If you cannot find the information you are looking for here and have further questions, please email Joanne Seader, RN, BSN, CDN, Director, Kidney Care Program, at Joanne.Seader@ibx.com. Be sure to include your name, contact number, and provider ID number in your email.