Medicare Chronic Care Management program

More than 45% of the American population is suffering from at least one chronic condition. CMS had an insurance policy to reimburse the hospital expenses of chronic patients. Due to inefficient care, the patients were readmitted to the hospital. This, in turn, increased the Medicare reimbursements. Medicare identified the need for continued care to patients with chronic conditions. In order to cut down on insurance expenses and provide continuous care to patients, Medicare introduced the Chronic Care Management (CCM) program.

In 2015, Medicare introduced the Chronic Care Management (CCM) program. It is defined as non-face-to-face services provided to its beneficiaries. In addition to office visits and other face-to-face encounters (billed separately), these services include

• Communication with the patient
• Health professionals being available both electronically and by phone for care coordination, medication management, and being accessible to patients.

Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

• Expected to last at least 12 months or until the death of the patient.
• Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.

CCM Service Summary

The following are steps through which a Chronic Care Management service is furnished,

1. Initiating Visit –  Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of Chronic Care Management services.
2. Structured Recording of Patient Information Using Certified EHR Technology –  Structured recording of demographics, problems, medications, and medication allergies using certified EHR technology.
3. 24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified healthcare professionals or clinical staff and continuity of care with a designated member of the care team.
4. Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-centered care plan.
5. Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

Why Chronic Care Management?

Most practices have a large population of patients with two or more chronic conditions. In fact, 68% of Medicare patients fit this description. The goal of a practice is to help their patients get healthier and improve their overall standard of living. This can be tough in case of chronic patients who require significant additional support. The practice may not have the resources to provide care. Without the proper systems in place, treating patients with chronic conditions is difficult to manage. That’s when the Chronic Care Management (CCM) program comes to play.

CPT codes for CCM

99490	$42	CCM services for at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month
99487	$60	CCM services for at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month
99489	$47	Each additional 30 minutes of clinical staff time directed by a physician or qualified healthcare professional per calendar month.

Chronic Care Program Requirements

One of the biggest obstacles that prevent medical practices from engaging in these programs are the inherent requirements for Medicare reimbursement. Some of these requirements include:

• An established care team
• A thorough care plan
• 24/7 access to clinical staff
• Coordination with clinical providers
• 20+ monthly minutes of non-face-to-face care coordination

Partnering with CCM

With the available finite resources, the practice can partner with CCM services. Chronic Care Management services have the following advantages,

• Good Medicare reimbursements depending on the service given
• Ability to provide care and support to the patients for managing their conditions better
• No additional cost if billing is managed within the network.

HealthViewX Chronic Care Management solution features

As the requirements of Chronic Care Management program are more, practices face difficulty in meeting the requirements. HealthViewX Chronic Care Management solution supports the following features that simplify the process,

• Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
• Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
• Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
• Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
• Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
• HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. All patient-related documents are managed securely.

HealthViewX Chronic Care Management solution is on par with the current requirements. It helps the practice to set up a CCM program with the least investment. To know more about our Chronic Care Management solution, schedule a demo with us.

 

References

1. www.fightchronicdisease.org/sites/default/files/docs/Almanac_FINAL.ppt