Approximately 71% of the total healthcare spend in the United States is associated with care for Americans with more than one chronic condition. Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for 93% of total Medicare spending.
It is said that a large percentage of these expenses are associated with acute care and emergency visits that could be prevented by earlier intervention. Patients who have multiple chronic conditions require ongoing medical attention. Putting further emphasis on health programs with an eye towards preventing and controlling chronic disease is one of the ways to address such costs.
The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.
What Physicians need to understand?
Medicare’s Chronic Care Management program has a primary clinical goal which is improving the health of Medicare patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient, and who are at significant risk of death, acute exacerbation/decompensation, or functional decline. In addition to understanding the service-level parameters, pay levels, CCM codes.
PCP’s and other health organizations who provide CCM services need to understand how to effectively bill for CCM in order to profitably achieve that goal.
Some of the basic preconditions that providers must satisfy are:
- the provider is required to complete an initial face-to-face visit
- obtain verbal or written consent from the patient, and develop a comprehensive care plan in the electronic health record
- provide 24/7 access to care
- use a certified EHR to aggregate all patient health information
- establish continuity through a designated care team member who works with the patient to implement a dynamic plan that spells out the patient’s key prevention and treatment goals and strategies
Who all can provide CCM services?
Additionally to physician offices, Chronic Care Management Services can be provided by
- Federally Qualified Health Centers
- Rural Health Clinics
- Critical Access Hospitals
And the following healthcare professionals can bill for CCM services
- Physician Assistants
- Nurse Practitioners
- Certified Nurse-Midwives
- Clinical Nurse Specialists
Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.
Why provide Chronic Care Management Services?
It benefits both providers and patients. Patients will receive better-coordinated care thereby preventing hospitalization and re-admissions. Providers will not only receive payments for providing care but also improve practice efficiency, compliance, patient satisfaction, and health outcomes. Practices, large providers, and health systems can add net new recurring monthly revenue.
How do physicians and other providers document the CCM services that are provided?
Some practices do the tracking manually, while some of the practices have CCM documentation built into their EHR’s. Other practices implement specialized CCM software to track time and ensure all the CCM requirements are met. Some of the CCM software has the ability to track not only the documentation but also send reminders or notifications to the patient, provider and other healthcare professionals involved in patient care.
How to make CCM profitable?
Chronic care management requires 24/7 access to care. Practices take different approaches to meet this requirement to provide better care coordination. Some practices hire additional staff and some opt for a solution to automate the end-to-end process to cut down on additional staff expenses. Considering healthcare IT will not only cut down on additional expenses but will also make CCM more effective and efficient.
Talk to HealthViewX solution experts to understand more about HealthViewX CCM solution and make your CCM profitable.