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Tips to Deliver Effective and Profitable Chronic Care Management

Posted by Aprillice Alvez on May 21, 2020 9:03:06 AM

profitable chronic care management


With the global pandemic, providing practical and profitable chronic care management has never been more critical. People with chronic conditions are high-risk of the coronavirus 2019 (COVID-19). The fact is alarming, for there are 133 million Americans who have a chronic disease. That’s about 40% of the population. There is a reduction in patient volume and services because of social distancing and the fear of COVID-19. Clinics and healthcare providers continue to assist with telemedicine options to increase patient care and grow their revenue. Here are some tips on taking your chronic care management (CCM) to its optimum capacity. 

  • Regulate your CCM process

Firstly, having a specific staff or team to handle your chronic care management will help you along the way. You can regulate a standard enrollment workflow to billing for a smooth process. Recommend your patients during clinic visits for CCM. A healthcare provider will confirm if the patient has two or more chronic diseases for eligibility for the CCM program. With the right staff for your CCM, it will be easier to convince your patients to apply.

  •  Enhance processes for ongoing CCM program

Secondly, CCM has a lot of requirements for providers. The condition includes a time of care through phone, text or email, and monthly outreach schedules outside of office visits. As hectic it might sound, you can assign most of it to your staff, nurse specialists, nurse practitioners, physician assistants. They should have a medical license in the state where the patient is receiving care. The patient outreach involves medication reconciliation and updates on the patient’s self-management on the treatment. It also requires follow-ups, adding, or modifying care plans based on their needs. Lastly, the healthcare provider will review and adjust the care plan as necessary and inform the patient of the changes. 

  • Be time conscious in filing claims. 

Make sure to file CCM reimbursement claims monthly. CCM fee requirements are confusing and overwhelming. However, there are tips available on how you can simplify the process. It will also help your practice have adequate reimbursements for providing quality care to CCM patients

  •  Keep it updated

Above all, you should never be complacent about your processes and always check on it from time to time. The world is ever-changing, and a few tweaks here and there may help your practice. Also, always make sure that you are providing topmost care and enrolling patients consistently. 

  • Be updated on commercial payer reimbursement opportunities.

 Most importantly, you should frequently check if commercial payers reimburse higher rates for active chronic care management patients. Some commercial payers offer lesser requirements and 15 to 20 percent higher reimbursement rate than medicare. 


How effective is Chronic Care Management?

There is an abundance of evidence that chronic care management does work. Studies show that the conditions of patients who have diabetes improved through receiving care outside of in-person care. Regular patient engagement and follow-ups resulted in a decrease in glucose and blood pressure levels. Additionally, a study also concluded that hospital readmissions for people with cardiovascular diseases are significantly lower with chronic care management compared to routine care patients. According to research, the CMC program substantially reduces mortality. It includes positive effects on the frequency of hospitalization and improves the quality of life. 

The five tips above will improve the conditions and the quality of life of your patients. Chronic care management will also improve the fiscal and revenue cycle health of your practice. 

Tips for Documentation

  1. Firstly, prepare a standard draft of a letter of authorization for your patients for chronic care management services. The patient should sign for consent, and the physician will add it to their EHR. Medicare reimburses for those services as long as the patient understands and consents to the services before billing. A healthcare provider shall explain and review the letter during the face-to-face visit before billing the CCM services. Include the following in the message:
    • Detailed information about CCM and its availability 
    • Instructions on how the patient can revoke the service
    • An explanation on why only one provider can bill for the services availed by the patient
    • Information shared between healthcare providers
  2. Secondly, medicare requires the billing of the Annual Well Visit or Comprehensive Evaluation and Management code preceding the CCM services. There should be documentation of the discussion between the patient and the healthcare provider, the letter. Then the care plan will follow during the first visit.
  3. You may want to have an EMR/EHR template that your clinical staff can use in documenting per CCM service. The EHR template needs to have the following:
    • elements on the care plan during the first consultation
    • necessary demographic information
    •  information on medication and allergy
    • letter of consent
    • information on clinical summaries for other physicians
  4. Provide a system for your clinical staff where they can keep a record on time spent per non-face-to-face services that include:
    • Prescription management 
    • Medication management and reconciliation
    • Email communication and phone calls with the patient
    • Time on care coordination with other physicians and healthcare providers through phone calls or other digital communication.
  5. Take note to use the calendar month for the date of service range when you are billing for chronic care management services. For example, 05-01-2020 to 05-31-2020.
  6. Lastly, your practice needs a consistent staff or system for documentation to ensure proper reimbursement. You may also either insource or outsource. Your need may depend on your medical team and EHR configurations.

How can Chronic Care Management boost your revenue 

Firstly, it gives practices another streamline of revenue. Having another source of income is essential during this global pandemic, where every nation is struggling financially. Your practice can earn up to $85K per year per billing provider. Lastly, it is also essential to add this to your practice, especially if you are having a low volume of patients due to COVID-19. 

Benefits in outsourcing your Chronic Care Management 

DrCatalyst is a trusted and proven remote staffing partner. Our staff of dedicated healthcare professionals working as an extension of your team. There are a lot of reasons why you should partner with DrCatalyst for your Chronic Care Management. Here are some examples: 

  1. Patients
    • Improved quality of life
    • 24/7 access to healthcare support
    • Personalized care plans
    • Lower healthcare expenses
    • Additional health coaching
    • Support offered to reinforce healthy habits
    • More engagement means better outcomes
    • Decreased EHR visits, hospitalizations, and unnecessary procedures
    • Health care Providers
  2. Improve patient outcomes
    • Additional CCM revenue
    • Improve your MACRA/MIPS Scorecard
    • Decrease administrative workloads
    • Enhance patient satisfaction
    • Improved workflow
    • Reduced burden of managing Medicare patients 

Partner with DrCatalyst for your CCM 

In conclusion, your patients will receive the extra care they need, your revenue will significantly increase and you’ll receive peace of mind with detailed reporting and documentation to back it up! So what are you waiting for? Talk to DrCatalyst today to learn more. 

Topics: CCM

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