How to Maximize Patient Enrollment in your Medicare Chronic Care Management Program

If you have ever considered starting a Chronic Mare Management (CCM) program, you likely know about Medicare’s compliance requirements in providing non-complex CCM services, including:

  • Twenty minutes of meaningful clinical staff time spent on every CCM patient, each calendar month
  • All activity recorded in a comprehensive care plan and shared within the Electronic Health Record (certified EHR)
  • Enrolled patients must have two or more chronic conditions, and had an office visit in the past year
  • Although patients can only be enrolled under one provider, the type of health care provider can vary from primary care to certain specialities
  • The compliance requirements for enrollment conversations, including that all consents must be recorded, you must discuss the coinsurance and deductible obligations, and that the patient is free to unenroll at any time

While the Centers of Medicare and Medicaid Services (CMS) lays out these guidelines for you, they don’t provide a guide for how best to perform your CCM program. What you may not know are the details of how to successfully enroll your Medicare beneficiaries into your CCM program. There is a lot more to it than just asking patients if they would like to join your program. In this blog, we will explore the most important components of a successful patient enrollment process. 

Start With the Data 

The first step to maximizing your enrollments is to look at your patient data. Not all Medicare patients qualify for CCM services. Cpt code 99490 can only be billed for Medicare beneficiaries with two or more chronic conditions that cause “functional decline, decompensation, and/or significant risk of death to the patient.” There is a large list of health conditions that are considered chronic, so it’s important that you know what qualifies and what does not. Your Enrollment team will need to reconcile against the CMS chronic care database and update it frequently to reflect any changes. You will also need to make sure your patients have been seen within the past year. 

Since your patient data is constantly changing, enrollment will be an ongoing function. This portion of your CCM program will be one of the heaviest lifts as it will take continuously scrubbing your data to identify new eligible patients. Since this is such a time-consuming function, it’s recommended that you rely on a dedicated medical data expert within your practice or a trusted CCM partner. 

The accuracy of your patient data is crucial to maximizing your eligible patient list, because if it is not up-to-date, you are not only missing the opportunity to help those patients, but you are losing out on significant revenue. Reconciling missing CPT codes or problem lists, identifying provider/patient changes, and identifying missing demographic data will be an important recurring activity in running a quality and compliant CCM program. 

The Ideal Enrollment Specialist

At first you may consider repurposing your clinical staff to enroll your CCM patients.  That would be a mistake. Health care professionals go through years of training…for clinical work. That training does not include skills for a sales-focused role that requires them to generate value propositions and respond with rebuttals. Chronic Care Management typically requires a monthly coinsurance obligation from the patient, which can often be a hurdle to get patients enrolled. It is critical that your Enrollment Specialists have access to claims data and can articulate the exact patient copay obligations to a consenting patient. For these reasons, health care professionals are not the staff who you want enrolling your patients. Instead, your Enrollment team should be marketing-minded with the underlying knowledge of the program, as well as the CMS requirements, and compliance regulations. This will help you achieve the highest conversion percentage of patient consents for your care management program. 

Care Management Services

Once your patients are enrolled, non-complex CCM requires a minimum of twenty minutes of meaningful, non-face to face care each month for every patient. This care can be completed by a variety of qualified health care professionals, including but not limited to physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified health coaches. Since your care management services can be performed by a care team of non-physicians, which means your providers can be relieved of a workload that would otherwise be time-consuming, not the best use of their skills, and a low margin activity. . 

At this point, your Enrollment team should no longer be involved with the patient. However, the care coordination services that your care team provides is crucial for your Enrollment team to understand because they will be responsible for encouraging the patient to join your program. The Enrollment team will need to be properly trained so they understand the benefits of care management services. This will take extensive training which is why establishing your Enrollment training curriculum with a dedicated trainer and quality assurance program or using a partner who specializes in enrollment services is a great option to consider. If you are considering launching a CCM program,  for the best enrollment outcomes, reach out to a ChartSpan expert today. Or, check out an enrollment success story with one of our customers. 

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