Monthly Archives: March 2017

Chronic Care Management – Decoded (FAQ)

Chronic diseases are a long-term illness that needs special care and periodic evaluation. Conditions such as diabetes, cancer, heart diseases, high blood pressure and so require continuous care and help.

Both diagnosis and treatment cost of any chronic disease is very expensive. And, if a person has multiple chronic conditions, the costs will skyrocket. That’s where Medicare comes to play, like other health insurance it pays half of the treatment and care cost.

What is Medicare?
Medicare is a health insurance program administered by the U.S. Federal government for people aged 65 or above, and for people with certain disabilities and end-stage renal disease of any age.

What is Medicare Chronic Care Management service?
Under Medicare payment, a Chronic Care Management service will be provided to patients with multiple (two or more) chronic conditions by a physician or skilled professional per calendar month.

Examples of the chronic condition include, but not limited to, the below list

- Alzheimer’s Disease and Related Dementia		 - Heart Failure
- Arthritis (Osteoarthritis and Rheumatoid)		 - Hepatitis (Chronic Viral B & C)
- Asthma						 - HIV/AIDS
- Atrial Fibrillation					 - Hyperlipidemia (High cholesterol)
- Autism Spectrum Disorders				 - Hypertension (High blood pressure)
- Cancer (Breast, Colorectal, Lung, and Prostate)	 - Ischemic Heart Disease
- Chronic Kidney Disease				 - Osteoporosis
- Chronic Obstructive Pulmonary Disease		         - Diabetes
- Depression						 - Stroke
- Schizophrenia and Other Psychotic Disorders

What is CPT 99490?
Chronic Care Management Services, takes at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Comprehensive care plan established, implemented, revised, or monitored

What are the new complex CCM codes?
CPT 99487 – Complex Chronic Care Management Services, with the following, required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Establishment or substantial revision of a comprehensive care plan
● Moderate or high complexity medical decision making
● 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

How do physicians get paid for CCM services?
Mostly primary care physicians can bill for CCM service and in some cases, specialists involved in care can also bill. But only 1 practitioner can be billed per patient per calendar month for either complex or non-complex code.

What is the best way to keep track of chronic care minutes?
Care providers generally keep track of the service time. A tracking software can be used to track every minute spent on care and documentation is done for reimbursement purpose. Based on the service offerings, time will be tracked for every interaction made with the patient on a monthly basis.

How to start Chronic Care Management to patients?
Patient with multiple chronic conditions first needs to enroll for CCM care service. Then physician or care professionals will provide care according to needs of the patient. This service will be then documented for billing.

Is there any chronic disease Self- Management Program?
Yes!. A low-cost Chronic Disease Self-Management Program (CDSMP) helps chronic patients to learn how to manage and improve their own health. An interactive session will be conducted for patients with the common disease by doctors that cover pain management, nutrition, exercise, and medication use.

Home Health Care for Chronic Disease Management

Home health model is established with an objective to deliver high-quality care at each level of healthcare delivery chain. As we all know this is offered at the patient’s residence by either licensed health care providers or caregivers.

Home Health Agencies are certified centers that provide skilled care for older Americans, people with disabilities or for people who suffer from acute and chronic conditions.

There are about 83.7 Million people in the US who are benefiting through home health agencies.
As a result of this parallel growth of both aged population and chronic diseases, the need for optimum care delivery continues to grow.

For elder care help, CMS offers to pay home health agencies for providing 60 days of care under HHA PPS.
So, how does home health agencies get patients?

On the basis of illness or injury, doctors send people who need care services to home health.
Mostly Medicare patients, people with 2 or more chronic conditions who need care after discharge will be shifted to home health immediately following hospitalization.
Patient-centric care is provided to see quick progress in their health considering the needs of the patient and doctor recommendations.

How does a care coordination model work?

Once a patient is referred, a care plan is set with goals to regain patient health status. Some home health agencies have started embracing technology platforms through which automated care plans can be generated using Care Management Software.

Care plans are set with goals and rolled out to patients. Health status will be continuously monitored by skilled professionals at regular intervals and if required changes will be made looking at real-time health data.
Both patient and the providers are equally involved in the care cycle and are expected to work together and achieve health goals to ensure patient recovery.

Multiple specialists will be connected in this care loop to better collaborate, communicate and coordinate care whenever there is a necessity or emergency.

Coaching will be given with the help of patient education tablets to connect and follow the care goals for quicker recovery. Home health also organizes a community meeting where people facing the same kind of illness will share their experiences to encourage and motivate to fight against chronic illness.

Telehealth Home Service

Many US seniors enjoy living independently at their own place and need a little help from providers when they get ill. Telehealth is a gift for those to improve their health thus promoting independent living.

Telehealth program is technology integrated with clinical care to change the healthcare delivery, model. Some healthcare providers have already implemented this telemonitoring service that will guide patients through a daily check-up, and also record vital signs and symptoms.

These details will be then sent to a central monitoring system, from where home health agencies will be receiving an alert in case of emergency.

Challenges faced by Home Health

Technology Changes
From Health Monitoring Systems to medication tracking devices, technology is expanding at ever-increasing speed and home health struggles to keep up that pace.

New technology is presenting new methods for providers, and of course, home health agencies to connect with their patients but this can also be problematic. From the cost involved in procuring such technologies to patients perception. Changing legal and regulatory climate around the use of technology in the field of healthcare adds to the problem.

Lack of care continuum
Among long-term care patients, 90 percent of them live in their own homes to avoid hospital environment. Increasing demands due to rising older population makes the delivery model challenging to provide affordable, continuous care and to meet the expected quality parameters.
Adapting to changes in government regulations and practices also influences the style of functioning of the system.
Value-based physician reimbursement for improving quality and lack of skilled professionals are some of the areas that need immediate attention.

Employing technology can help in improving care delivery, and admittedly choosing the right solution that meets the needs of the practice is the key to success in the ever-changing healthcare environment.

HealthViewX Care Management Solution allows to create and send customized care plan for individual or group of patients to help manage the health of the whole population. Integrated telehealth feature enables provider to connect with patients quickly and track patient’s health condition remotely.