800-376-0212 contact@carevitality.com

Why the Need for the Chronic Care Management Program?

The Financial & Human Cost of Chronic Disease in The United States is Staggering. Check Out The Chart Below.

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Chronic Care Management (CCM) Explained

Find Out More About Chronic Care Management Below

Beginning January 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. The average reimbursement per qualifying patient per month is $42.

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Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • Comprehensive care plan established, implemented, revised, or monitored.

New conditions are being added as CMS has elaborated on the definition of a chronic condition. Examples of chronic conditions include:

  • Alzheimer’s disease and related dementia
  • Chronic Kidney Disease
  • Cancer (almost all cancers)
  • Glaucoma
  • Anemia
  • Asthma
  • Chronic Obstructive Pulmonary Disease
  • Diabetes
  • Hypertension
  • Osteoporosis
  • Chronic Pain & Fatigue
  • Atrial Fibrillation
  • Obesity Stroke
  • Cataract
  • Arthritis (osteoarthritis and rheumatoid)
  • Autism Spectrum Disorders
  • Depression
  • Heart Failure
  • Ischemic Heart Disease
  • Migraine/ Chronic Headache
  • Fibromyaglia

Physicians and the following non-physician practitioners may bill the new CCM/TCM service:

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants

Only one practitioner may be paid for the CCM service for a given calendar month.

Note: Eligible practitioners must act within their State licensure, scope of practice and Medicare statutory benefit. The CCM service may be billed most frequently by primary care physicians, although specialty physicians who meet all of the billing requirements may bill the service. The CCM service is not within the scope of practice of limited license physicians and practitioners such as clinical physiologists, podiatrists, or dentists, therefore these practitioners cannot furnish or bill the service. However, CMS expects referral or consultation with such physicians and practitioners by the billing practitioner to coordinate and manage care.

CMS provided an exception under Medicare’s “incident to” rules that permits clinical staff to provide the CCM service incident to the services of the billing physician (or other appropriate practitioner) under the general supervision (rather than direct supervision) of a physician (or other appropriate practitioner).

We provide all the tools and resources needed to Participate in the CCM Program and allow you to begin receiving the Financial Benefits quickly while improving the health of your chronically ill Medicare patients. We do all the work, which gives you access to this Incentive Money without placing burden on your practice or your staff!

Care Vitality - CCM Explainer Video

The Benefits Of CCM

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Providers

Make up to $300,000 a year gross annual revenue

We schedule all the CCM patients Preventative and Health Maintenance appointments increasing in-office encounter revenue 20%- 30% on average

Improve your quality measures for other incentive programs

Stay focused on in-office patient care and let our staff provide the non-face-to-face burden of your chronically ill Medicare patients

Free up time to either enjoy time outside of the office or potentially see more patients

Satisfied patients are more likely to adhere to their care plans and continue to be treated by providers that are invested in improving their health

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Patients

Care Management services provide a continuum of care for patients to improve patient outcomes and reduce total cost of care

Providing 24/7 access to care provides patients with the support needed to better manage their chronic conditions and overall quality of life

Continued care management of the patient improves adherence and patient literacy so they can take an active role and proactive approach to managing their overall health including diet, exercise and nutrition

Care management support addresses gaps in care, provides assistance managing chronic conditions and episodic problems that may otherwise go unaddressed, resulting in poor patient outcomes, costly hospitalizations, procedures or additional chronic disease states

Improved patient adherence and compliance starts with education and literacy. By providing essential patient-centric information patients can understand the need for compliance and be better informed to make the correct decisions in self- management

Patients participating in the CCM program have access to 24/7 care support provided by our RN Clinical Care Team

Challenges

Challenges to Value-based Care

Research studies have demonstrated time and again that providing care management improves patient outcomes and reduces total cost of care. CMS recognizes these numerous studies conducted over the last decade that demonstrate that Care Management provides patients with chronic conditions with the much needed support and health coaching to improve quality outcomes and reduce total cost of care. However, there are several challenges that have prevented many providers from participating in the Chronic Care Management Program and other value- based care initiatives.

Burden Of Time

Burden Of Time

Managing Internal Resources

Managing Internal Resources

Protecting (ePHI)

Protecting (ePHI)

Cost of Resources

Cost of Resources

Liability

Liability

Compliance

Compliance

Third-Party software

Third-Party software

Documenting Appropriately

Documenting Appropriately

Fear of Penalties

Fear of Penalties

Hiring the Right Resources

Hiring the Right Resources

Outcomes

CCM Engagement & Interactions

Care Vitality - Care Continum

Our Turnkey Offering

Patient Identification

Patient Identification

Using our sophisticated software tool along with reports from your EHR, we identify all of your Qualifying CCM Patients.

Patient Outreach

Patient Outreach

We engage your qualifying CCM patients to educate them about the value of the program and if necessary schedule their next office visit in order to gain consent.

We Provide Assistance With Setup

We Provide Assistance With Setup

We work with Providers and their System Administrators to get user access to their EHR/PM and Patient Portal Systems and set up the phone tree so patients can have direct access to their CCM Clinical Care Manager.

We Train Your Staff

We Train Your Staff

We train your staff on how to identify CCM patients and educate them on how to engage CCM patients.

Customization Of Your EHR

Customization Of Your EHR

We have experience working on over 150 EHRs, we determine if your system needs to have customized templates created and then develop them to meet the CCM program requirements.

We Develop The Comprehensive Care Plan

We Develop The Comprehensive Care Plan

We do the work for you, we develop the Comprehensive Care Plans based on the conditions of the patient and have the provide sign off on it.

We Begin Patient Engagement

We Begin Patient Engagement

After implementation our Clinical Care Managers begin the CCM services by engaging with the CCM patients to provide the required guidance and oversight of their Care Plan.

We Manage & Monitor The CCM Patients Care

We Manage & Monitor The CCM Patients Care

As the condition of the patient changes, we change their care plan if necessary to provide an accurate continuum of care, each change must be signed off on by the CCM provider.

We Facilitate Care Transitions

We Facilitate Care Transitions

We communicate with CCM patients, their CCM providers and other providers responsible for the patient’s care, we manage their care transitions between other setting and other providers and ensure that becomes part of their patient chart.

We Document Our Work

We Document Our Work

All communications are documented within the CCM templates in your EHR and housed within the patients electronic patient record for your continued access and review.

We Provide Auditable Reports

We Provide Auditable Reports

At the end of each month, we provide your staff with an auditable report of the work completed by our Clinical Care Managers so you can easily bill the 99490 code for your CCM patients.

Chronic Care Management (CCM) Revenue Calculator

Family Practitioner CCM Revenue Calculator

Calculator
Description Your Value
Annual number of unique patients (U.S. average per family medicine provider: 32791)
Percent of patients covered by Medicare (U.S. average: 21.85%1)
Annual number of unique Medicare patients
Percent with 2+ chronic conditions (U.S. average: 68.60%2)
Annual number of unique CCM patients
CCM monthly payment (U.S. average: $41.443) or select your locality
Estimated annual CCM reimbursement for family medicine physician

Specialist CCM Revenue Calculator

Calculator
Description Your Value
Annual number of unique Medicare patients
Percent with 2+ chronic conditions (U.S. average: 68.60%2)
Annual number of unique CCM patients
CCM monthly payment (U.S. average: $41.443) or select your locality
Estimated annual CCM reimbursement for a speciality provider

1Per the MGMA Cost Survey for Single Specialty Practices: 2013 Report Based on 2012 Data specific to the specialty of family medicine. Includes Medicare A/B and Medicare Advantage.
2CMS.gov – County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.
3Reimbursement amount from the CY 2015 Physician Fee Service Final Rule, October 31, 2014, averaged across 89 localities.

Learn How CareVitality Can Make a Difference for Your Organization

Let us know how to reach you or call us at 800-376-0212

CCM Patient Testimonials

Even if I have to pay a co-pay I want this program because it is exactly what I need to feel better about my health conditions and enjoy life more.

Maria

This program is perfect for me because I live alone and it is reassuring to have someone that checks on me and cares about my health.

Sophia

CCM Offering Brochure

The Centers for Medicare & Medicaid Services (CMS) recognizes care management as a critical component of primary care that contributes to better health and care for individuals, as well as reduced spending.

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