According to the Centers for Medicare and Medicaid Services (CMS), there are over 117 million adults with chronic conditions, and one in four of them have two more chronic illnesses. Chronic Care Management (CCM) is a specialized program to maximize services for these vulnerable patients – those who have 2 or more chronic conditions. CMS added Chronic Care Management as a Medicare reimbursable service in 2015, but providers under-utilize this program because the CCM requirements are often not clearly understood. These requirements are many, although once set up correctly, updates and changes are all that is needed on a monthly basis.
Patient requirements for a CCM program
- Two or more chronic conditions, each of which would be expected to continue for 12 months or until the death of the patient.
- Chronic conditions that place the patient at risk of death, acute exacerbation of the condition, or a functional decline in abilities.
- Must have a comprehensive care plan established, implemented, revised, and monitored.
So, what constitutes a comprehensive care plan? The elements which meet CMS requirements include a problem list, expected outcome, patient goals for care, treatment plan for EACH chronic condition, a symptom management plan, documentation of education resources provided, the listed care team with roles and responsibilities, a documented and reconciled medication list, documentation of community and social services involvement, and a care plan review date. This documentation burden is a big reason why some providers have not delved into creating a CCM program yet.
A structured CCM program benefits both patients and medical practices in several ways.
Patient Benefits
Patients benefit from a more connected care plan, routine visits, and specialized monitoring of multiple diseases. Complex regimens of medications, diet changes, and self-monitoring can be overwhelming and isolating. A personalized, targeted care plan can be key to successfully managing chronic illnesses for the best possible quality (and quantity) of life.
Chronic Care Management may include:
- A minimum of 20 minutes per month of CCM services
- A dedicated health provider to work with each patient to create a personalized care plan
- Coordination of care between primary physician, specialists, pharmacy, testing centers, the hospital, and more.
- Emergency access to a health care professional – 24/7
- Help with setting and meeting health goals
Medical Practice Benefits
Maximizing patient reimbursements by adding up to $42 dollars per patient per month for CCM – and taking credit for care that is often already being provided – is a big incentive! With a structured program and correct documentation and workflow, significant revenue can be added for providing these valuable services. These services can be face-to-face or virtual/telephonic and provide opportunity to truly reach patients and spend the structured time they need to stay on top of their chronic conditions and meet health goals. Physicians and advanced practice nurses and physician assistants can bill for these services. CCM is available for federally qualified health centers, rural health clinics, and critical access hospitals as well – adding important rural health benefits.
To get started the right way with this complex program, providers need a framework to hit all the required elements in an organized way, and to bill efficiently. Otherwise those 20 minutes spent with the patient turn into hours of documentation.
How Novomedici Can Help
Novoclinical’s EHR solution for CCM is prepared to help all types of medical practices avoid the pitfalls of starting a new CCM program and realize the results. Poorly managed CCM programs can be a nightmare for clinicians, leading to financial losses. A well-structured and efficient system can boost revenue, and more importantly dramatically improve the health of chronic disease patients. Providers can offer the thorough and personal care that they want to provide, while being assured that they have tools to do it right. To experience the power of Novomedici, schedule a free demo here, and contact us to receive more information. Become one of our many success stories with CCM!
References:
- “Chronic Care Codes Offer Greater Flexibility and Payment In 2020”. 2020. Medical Economics. https://www.medicaleconomics.com/view/chronic-care-codes-offer-greater-flexibility-and-payment-2020.
- https://www.hccinstitute.org/chronic-care-management-one-way-to-maximize-fee-for-service-reimbursement/
- https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/ccm/hcpresources