Chronic Care Management Guide

Creating a 360 value-added care in all directions with right moments to act

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Most people in the United States are exposed to at least one or more chronic conditions. With an unhealthy diet regimen, patient visits to clinicians’ offices have doubled – reducing the chances of delivering immediate care. Such a significant increase in patients created an unnecessary workload for practices.

It generates inefficiencies in medical care, contributing to hospitalizations, emergency visits, and losing hope to regain full health. Such circumstances created a gap to incorporate smart chronic care management solutions. The integrated solution within remote patient monitoring consistently tracks patients’ health vitals. Information is received on the practitioner’s screen to analyze health measurements.

Multiple chronic illnesses are collected on RPM devices that reduce expenses and lag time for a variety of specialties. Data visualization helps practitioners with immediate care if readings are inconsistent. Any rising complexities with individual health concerns are mitigated at the earliest without requiring any prior appointments or repeated checks.
Valuable time and expenses are minimized to ensure optimum delivery of care to achieve a high patient satisfaction score. Therefore, organizations and clinicians can ensure the best care for patients’ needs while increasing efficiency.

Chronic care management delivers a multitude of benefits. Practitioners can strengthen their bottom-line results by providing the necessary care and ensuring better lives for patients. Medicare and other large payers have endorsed CCM due to widespread chronic illnesses in millions of Americans. The practices can gain a sizeable portion of their income with chronic care management services by participating in the program.
Before launching the CCM program for your practice, it’s important to gain familiarity with some key concepts. It’s best to learn different CMS guidelines and coding for faster reimbursements and increasing your potential earnings. Here’s a comprehensive guide on everything you need to know for effective chronic and care management.

Introduction to Chronic Care Management
Section 01

Understanding chronic care management may seem straightforward, but it’s best to look at different factors that impact the evolution of CCM. With a solid grasp of CCM’s foundational concepts and coding guidelines, practices can strengthen their care delivery model.

Chronic care management needs arose for the ease of delivering better treatment and quick medical reimbursements. Technology-enabled CCM solution delivers convenience outside the confines of a certain hospital setting. Patients can receive immediate attention and care from practitioners in the comfort of their homes.

The need to travel long distances is almost eliminated with CCM while reducing the cost of improving health. Early treatment and time consumed with traveling are significantly reduced with precise examination and health monitoring. Correct health measures ensure increased engagement and reduced hospitalizations or readmissions.

Proceed with Chronic Care Management

Chronic care services are conducted outside the premises of a traditional hospital setting. Chronic illnesses encompass various diseases that are expected to last for a year and put patients at significant risk of death. CCM is typically a remote service that allows practitioners to bill for the 20 minutes of coordination each month.

With CCM services, it’s important for caregivers to diagnose a patient’s health for two or more chronic diseases that last 12 months or until the patient’s death. Any growing illnesses are intercepted for better care planning, so regaining health is more predictable.

The patient’s care team can generate bills for time spent caring for illnesses through services outside the perimeters of a traditional office setting. The care services may include creating a comprehensive treatment plan, remote interaction in executing medications, and coordination between providers.

Chronic care management comes under Medicare Part B to reimburse practitioners for the CCM services provided to eligible patients. However, there are different requirements that must be met for coding, billing, and faster earning with CCM.

As stated, patients that are exposed to two or more chronic illnesses for at least 12 months are eligible to gain chronic care management services. Usually, chronic diseases can decrease the patient’s mortality rate and be subject to increased surveillance. However, practitioners must also satisfy the Medicare criteria for patients exposed to different illnesses. For curious minds, there are several conditions that fall under CCM, but you can check with examples below:

Eligibility Criteria for CCM

You did the hard work of collecting and diagnosing the patient’s health. Now, how can you get paid faster? It’s important to first clear through the basics of coding and billing to completely grasp the concept of chronic care management. Practitioners can collect their reimbursements with chronic care management at the end of each month. Medicare has provided certain codes against each disease to collect payments or reimbursements for the treatment.

The chronic care management codes: CPT 99490 and CPT 99491 require an enrollment of two or more chronic conditions that appear for at least 12 months or until death. Chronic conditions put patients near death with deteriorating health that requires a comprehensive treatment plan to mitigate risks. Furthermore, explicit consent is required from the patients to enroll them in a chronic care management program.

Initially, Medicare limited the time allotted for reimbursement with the CCM program. To increase practitioners’ participation in chronic management services, time allotment was expanded and billed with other CCM codes. However, people with more complexities require more time from physicians and clinical staff.

Nurses, practitioners, clinical specialists, and physician assistants may all bill for providing CCM services; only one caregiver can get reimbursed for each patient with the CCM program within a certain calendar month. Moreover, practitioners should report their CCM services for each patient in a certain month.

Overview of CCM Codes

For a better understanding of chronic care management, we must look at how it helps with a certain chronic condition that benefits both patients and practitioners. Careful planning with CCM ensures increased efficiency of managing efficiency and controlling any evolving risks.

Hypertension can be considered close to a pandemic that is consistently increasing the count of patients. With the disease, the blood pressure pushes on the fragile arteries and veins. It silently resides in the human body and slowly spreads as an infectious disease – contributing as a single cause of heart attacks, strokes, and heart failure. Therefore, it’s important to identify the illness as early as possible to mitigate risks and slow its spread before patients are near death.

People diagnosed with the disease, only one-quarter have it under control. The lack of symptoms in hypertension often leads to mistreatment to curtail health issues. Practitioners encourage more seriousness and remotely monitor hypertension. Remote access allows patients to manage control over the disease and offer practitioners to evaluate the early symptoms precisely.

Although self-monitoring may seem like a viable solution – patient adherence is also required to take timely readings and remain on track with the treatment. With CCM, direct oversight isn’t required, as practitioners can check the data patterns gathered on the chronic care management system.

Moreover, practitioners had to spend countless unpaid hours educating patients on the new care delivery system. It meant strengthening the patient’s knowledge before beginning to diagnose and treat the evolving conditions. Recently, Medicare has started offering reimbursements for time spent educating patients, so the value of care is delivered with hypertension management.

CCM ensures healthy financial gains for practices with improved quality scores and patient adherence. Medicare is maximizing the return on investment for care organizations by expanding CPT codes for qualifying to every two or more diagnoses. Beneficiaries are compensated against various CPT codes that include complex chronic diseases and other conditions.

Value with care is delivered with early treatment and accurate management for improved patient experience. Contrary to the complexities in traditional hospital settings, practitioners gain a streamlined workflow that adds to increased reimbursements. With several benefits attached to chronic care management, it may seem the program may have widespread adoption. But it’s the case only if practitioners can understand the value of implementing the program.

Support for Hypertension with Chronic Care Management
Section 02

Value-powering features of chronic care management start building at the early stages of the implementation. Organizational commitment is a necessary prerequisite to the launch of a program. More importantly, patient adherence is also an additional factor to ensure overall success of the CCM program. Before undergoing with developing new workflows, training new staff, and the right software, patient adherence and education must be ensured.

Check whether the patients will opt for the new program and recognize its value. Are patients prepared to onboard easily on the new remote program? Will they provide consent for the CCM services? How ready are your patients with the knowledge of chronic care management? Asking yourself the right questions before moving with the investment.

With proper homework and understanding, you remove the guesswork from equations. Connect the right dots and add any missing pieces to attain a clear picture of your goals. You must also expect the expense incurred by patients before enrolling them into the program. For informed decision-making, it’s best to educate practitioners on their patients and how they will add value to deliver the best results.

Chronic care management can justify your investment with few benefits. Medicare Part B covers beneficiaries in CCM and is subject to the annual deductible of $233 in 2022 with 20% coinsurance.

CCM services may cost your patients somewhere in the middle of $7 and $10 every month for different demographics of your patient after meeting the deductible for a year.

Consider putting numbers for financial expenses into perspective. Adhering to your goal may even be cheaper with fewer out-of-pocket expenses. Fewer expenses can be attained with an overall understanding of the value offered by chronic care management. After looking at incredible savings, patients may be reluctant to ensure participation in the program. In the long-run cost of receiving care by people will seem minimum as compared to the traditional hospital setting. Certain organizations offer financial assistance to patients, so they can benefit from chronic care management.

Getting patients to buy your chronic care management services may reside on a few determining factors. Look at five benefits to convince your patients to onboard the new CCM program.

Minimized Hospital Expenses – Maybe your patients will find the jaw-dropping figure of $13,000 that includes diagnosis and physician fees. What if they can minus the huge figure to a few dollars by replacing traditional hospitalization with chronic care management services? You can justify the price with CCM, which includes more features and minimum expenses.

Effective Implications of Medications and Changing Symptoms — Practitioners can check the effectiveness of drugs and medication with chronic care management so harmful dosages or medicines can be removed at the early stages. Considering that Americans have high expenditures on drugs and medication, people can attain significant savings. Moreover, symptoms can be controlled by properly managing the medication and reducing the chances of deteriorating health.

Accessibility to Caregivers — Chronic care management eliminates lengthy waiting times and lagging of critical health-related information. CCM removes the complex procedure of visiting a doctor’s office and instead provides direct access to the practitioner. Patients can leverage the support and knowledge of a reliable medical source in case of any rising queries. Answers can be provided with a remote interaction with minimum time constraints.

Ensure Convenience to Secure Life — Chronic care management provides patients with remote access – providing ease and simplicity of interaction. Patients can utilize telehealth services for remote monitoring, tracking, and analyzing patients’ conditions. Care and vitals can be easily tracked through secure platforms that alert practitioners on growing risks.
The fast-paced method of coordination would allow healthcare providers to adequately assess the patient’s condition and improves the accountability of a care provider. It reduces trips to the doctor’s office and prevents the waste of crucial time spent on taking the ride to a longer route. Chronic care management services eliminate unnecessary visits and time spent in emergency rooms that add to higher costs for accelerated experiences.

Accelerate Care Coordination — It’s reported in recent studies that medical services like duplicating services such as imaging and lab testing contribute to $20 billion in healthcare costs every year. The growing cost to care can be minimized by incorporating efficient methods of care coordination that decrease any likelihood of wasting money on imaging and lab testing services.

CCM for Hypertension

Rescue Your Business with Tailored IT Solutions

Choosing the right chronic care management solution can ensure success or failure with the CCM program. Your pick should be simple that require the necessary due diligence to research your options with the chronic care management software. Let’s have a look at the key features to make an informed decision on selecting the right CCM software.

Cybersecurity — Consider the security features of chronic care management solution and how it secures patients’ data. Almost 89% of healthcare organizations have experienced data breaches in the last two years. Data breaches contribute to expenses that may translate into potential bankruptcy or disaster that can compromise the organization’s reputation.

It’s important to review the security features of chronic care management solutions and ask vendors about the training required to ensure better training for data security and protecting financial information. Check with the vendor if they offer education and support before patients enroll in the program. Informed patients will be prepared to take the right measures without compromising the integrity of the care organization.

Coding, Billing, and Reporting — Rules of Medicare and other payers may change for billing, reporting, and coding without any prior notice. It’s important to check with the CCM vendor if they are compliant with established procedures and CCM guidelines while complying with HIPAA requirements. Therefore, the CCM program must comply with reports that can be accessed easily.

Right Configuration — Ensure the CCM software easily configures with necessary integrations to eliminate redundancies. The integration should simplify the workflow and save practitioners time with a clear dashboard and alert system.

Automated System — Chronic care management software should ensure the organization’s efficiency with an automated system. Your practice should be able to automate certain processes or tasks below.

  • Checks the eligibility of your patients with chronic care management in the EHR portal.
  • Gathers and transmits patient data through CCM technology and converts it into charts or patterns.
  • Effective in maintaining billing data and reports.

Management of Patient Onboarding —
People enrollment with chronic illnesses is expected to increase with chronic care management. The right chronic care management solution identifies the eligibility of patients for the CCM program. Various diseases are covered with software that effectively measures the relevance of illness to adopt CCM services.

Better opportunities and benefits of chronic care management programs also support other care management services that include remote patient monitoring. RPM will play a significant role in closing health gaps and increasing the efficiency of practices. Detecting and analyzing behavioral health patterns in chronic conditions will become more manageable.

Therefore, it’s important to carefully consider chronic care management software and vendor. Adopting the correct software will ensure ease and simplicity of the CCM program while also impacting the return on investment. The right vendor will ensure the value of excellent customer service to maximize your investment because your success will determine the vendor’s success. Practitioners can attain the right pace to achieve their goals with a correct purchase.
However, your understanding may impact the bottom line and achieve any significant goals. Educate yourself thoroughly on chronic care management before taking the necessary steps.

Chronic Care Management Software Company

Wrapping Up:
 Why Now is A Great Time to Start Chronic Care Management

Chronic care management makes care exceptional with helpful insight into wellness and health. Resources and care teams are appropriately utilized to reduce emergency visits and streamline workflows. Practitioners are prepared to make informed decisions with insights into patients’ health that helps with improving engagement and boosting revenue. Simplified care coordination with CCM ensures better satisfaction for the patients and creates exceptional experiences.

Medicare facilitates caregivers by expanding reimbursements for chronic care management and covers most illnesses. With several offerings of CCM services, it’s the best time to realign your care goals on remote chronic management from traditional hospitalizations.