The primary driver of preventative care is improving patients’ health and quality of life. What isn’t as openly talked about is the effect that preventative care has on Medicare costs, including taxpayer savings, reduced patient spending, and new revenue for practices. Certain preventative programs, like Chronic Care Management, can make a significant impact on lowering costs and increasing revenue.
What is Chronic Care Management?
Chronic Care Management (CCM) was created by the Centers for Medicare and Medicaid Services (CMS) to help address issues associated with the aging population. As patients get older, they tend to accumulate more and more medical conditions that require additional attention and treatment. As the aging population grows, this can overwhelm providers and practices with an even heavier workload than they already experience. Thankfully, CCM programs provide an extra level of service to those aging patients with chronic conditions and can reduce the time and labor needed on the provider side.
CCM is specifically intended for Medicare patients who have two or more chronic conditions that put the patient in a state of decompensation or functional decline, a significant risk of death, and will last until the death of the patient. Patients must have visited their healthcare provider within the past year and can only be enrolled in a CCM program under one provider. Since patients are typically required to pay a small monthly copay for CCM, the program provider must obtain patient consent to be enrolled in the program.
Who can provide CCM?
Several types of healthcare providers can offer a CCM program to their patients, including primary care providers and certain specialities. When it comes to who can perform CCM services, CMS allows a wide range of providers to do so, including a variety of non-physicians such as nurse practitioners, physician assistants, clinical nurse specialists, certified nurse midwives, and other qualified health care professionals. This wide variety of health care professionals can perform CCM services under general supervision of a physician.
Why does Medicare Reimburse for CCM?
Since the program started, CMS has seen the proven results of non-complex CCM. They’ve seen that not only does it reduce hospitalizations by nearly 5%, reduce emergency department visits by 2.3%, and increase preventative care E&M encounters by 8%, but it saves patients in out of pocket healthcare expenses. It also saves taxpayers $74 (gross) and $30 (net, after provider reimbursement), per patient, per month, for every patient in a CCM program for at least 12 months. For these reasons, Medicare sees the value in reimbursing for Chronic Care Management services per patient, per month, billable under the CPT code 99490. Additionally, CMS will reimburse for complex CCM under the CPT code 99487 and the add-on code 99489. Complex Chronic Care Management is more involved than non-complex CCM, as it requires a full hour of clinical staff time each month and moderate or high complexity medical decision making. CCM services overall have shown that they are valuable in improving patient outcomes, saving money, and relieving providers of a heavy workload.
What services is the reimbursement for?
Since care management is performed as a non-face-to-face service, CMS has put strict requirements into place so that they can ensure they are reimbursing for a program that is valuable to patients. For every billable patient, CMS requires twenty minutes of clinical staff time spent working on the patient’s behalf and documented in the certified electronic health record (EHR). The documentation is referred to as the comprehensive care plan, which includes a summary of every interaction with the patient, their medical information and history, medications, provider list, and healthcare goals. Clinicians will follow-up every calendar month to address care planning based on the information in the comprehensive care plan. The care coordination team can also help with refilling prescriptions, coordinating referrals, assisting with transportation, and requesting health records.
If you are looking for a program that improves patient outcomes and can provide your practice with a significant new stream of revenue, look no further than ChartSpan’s fully managed Chronic Care Management services. Our team does everything from assisting your patients to helping you bill CCM services. Reach out to us today to start the transformation of your practice.
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