What makes a Chronic Care Management Program Succssful
Medicare expects providers to perform CCM services. The Centres for Medicare and Medicaid Services (CMS) consider CCM as an essential component of primary care which leads to better health and care for the patients. According to Medicare claims data, CCM can reduce unnecessary visits to hospitals and emergency rooms.
CCM saves Medicare around $74 per patient each month, or $888 per patient each year. These savings are because of the decreased demand for more expensive services like hospitals and more skilled nurses for care as well as better healthcare efficiencies.
If you want to get started with the CCM program then you will have to make sure that you take multiple steps to reach the appropriate patients. To get the most out of your program, meet any Centers for Medicare and Medicaid Services (CMS) CCM criteria. This is particularly true for individuals requesting reimbursement.
Market the Program with its Potential Benefits to Patients
Patients having two or more chronic illness conditions lasting from 12 months or patients who are at the highest risk of hospitalization or have recently visited the emergency room are best for CCM. Use your electronic health record systems to search for patients having relevant chronic illnesses. Run the diagnostic reports organized by the provider. Each practitioner can then evaluate their report to pick patients who they believe would be good fits for the program.
For a patient to receive the full benefits of a quality CCM program, he or she has to recognize it and how it works for them. Spend time and money on explaining CCM services to eligible patients and show them how the service takes their care beyond the four walls of the physician practice to help them achieve the best possible health.
Distribute educational material every time the patient is seen and display “Have you talked to us about our Chronic Care Management Program today?” in conspicuous areas. Simply create a marketing brochure that outlines the benefits of programs in straight English and keep it ready. It must explain how patients will benefit from monthly receiving telephone assistance in between regular consultations, as well as how they will be assigned to their care team to help them achieve better health.
Overview of the benefits of the CCM program should consist of the following services:
- Helps in setting appointments, lab tests, and other tests.
- Proper guidelines on how to take medications at any time or when altered.
- Making connections of the patients with the education resources, services, and programs.
- Helps in locating the resources for the community.
- Access to various assistance services.
- Giving answers to the questions on calls with a coordinator.
- The more patients are informed about this option of care, the more likely they will ask about it and join it.
Review Budget, Secure Consent, and Emphasize Care
Communicating Costs to PatientsScreening and Evaluation
Besides an explanation of benefits, it is also significant to communicate the price of the service to patients and they will take some financial risk. While many insurance plans, including Medicare, include the service, it is considered an out-of-pocket expense and patients are charged based on the patient’s deductible and coinsurance (typically 20%). This cost sharing may also be covered if the patient has another plan which is known as the secondary or supplemental insurance plan.
Informed Consent for Chronic Care Management (CCM) Program Enrollment
To enroll a patient in the CCM program, verbal consent is required, but obtaining written consent is highly recommended. Best practices include:
- Providing the patient with a copy of the consent form
- Clearly stating that patients can only enroll with one provider for CCM services
- Outlining the procedure for opting out of the service at any time
This ensures patients are fully informed and empowered to make decisions about their care.
Comprehensive Digital Care Plan for Chronic Care Management (CCM)
After obtaining the constent, the provider then must furnish the patient with a detailed digital care plan including:
- A detailed assessment,
- An enumeration of the patient’s present difficulties or conditions
- A treatment strategy and goals.
- Resources related to care and
- Medication Management
It should also contain a system to make sure all preventive care services are received on time and should be communicated to other clinicians and providers. Sharing the care plan through the patient portal of your current EHR is an inexpensive method of providing it.
Track Activity
Your practice must have a good system for tracking all the CCM activities including the time that the practice spends performing CCM services in the office or via phone call as well as the additional time that is spent on face-to-face and nonface patient care. CCm documentation must include all time spent on the activity and the content of the patient encounter every day.
Set up a system that can keep track of time spent on non-face-to-face services provided, including:
- Conversation with patients via emails or phone calls
- Time spent coordinating care with other clinicians, facilities, community resources, and health care providers and time spent on providing prescriptions for the management/medication reconciliation.
- You can make tracking operate flawlessly for your practice by tailoring the CCM program to your patient population.
Billing and Reimbursement for CCM
As for reimbursement, Medicare and some private payers offer reimbursement for Chronic Care Management services. Documentation and coding of CCM services require specific codes that will help in billing processes to avoid any denied claims. Here is an overview of the coding and billing considerations for CCM:
CCM CPT Codes
Chronic care management services are billed using CPT codes. The primary CPT codes for CCM are:
- CPT 99490
- CPT 99439
- CPT 99487
- CPT 99489
Documents Required For Billing
A comprehensive care plan, patient consent, and Electronic Health Record (EHR) are the kinds of documentation that are necessary for CCM services.
Time-Based Billing
Chronic Care Management services are reimbursed for the overall time spent on care management services. This includes non-physician touch activities like care coordination, medication administration, and patient counseling. Time spent on chronic care management including by clinical staff members should be combined to satisfy the minimum time requirements for each CPT code.
Frequency of Billing
The services provided under CCM may be charged every month. Make sure to code the right CPT code depending on the amount of time you have spent on care management. One must be abreast with the current coding and billing standards set by the CMS and private payers to get the right amount of reimbursement for the CCM services.
To get in touch call us right now at (713)715-7997 to learn more about our CCM services or you can also book a 30 min free consultation.
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