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How does Chronic Care Management Program help increase revenue?

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Physician attending a patient under Chronic Care Management Program

What is Chronic Care Management Program?

Chronic Care Management (CCM) is a program developed by the CMS for Medicare beneficiaries. It applies to patients who have two or more chronic illnesses, which can be expected to last for the next 12 months or till the death of the patient. Furthermore, these chronic conditions should place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

How does CCM help patients and providers?

Medicare says that Chronic Care Management offers additional help managing chronic conditions like Alzheimer’s disease, cancer, arthritis and diabetes. The CCM includes a comprehensive care plan that lists the patient’s health problems and goals, other providers, medications, community services, needs, and additional information about their health. It also explains the care the patient needs and how it will be coordinated.

Hence, Chronic care management is beneficial for patients in terms of ongoing health and wellness support. It increases access to appropriate medical resources, improves communication with members of their care team, drops in emergency room visits and hospitalization. CCM ensures higher involvement in the patient’s well-being. 

CCM is not just helpful for patients, it benefits practitioners, too, including improved care coordination, happier patients, compliance, and increased revenue.

What are some of the CCM Services?

CCM services are generally non-face-to-face and are considered critical components of primary care by CMS. These services must be documented in the electronic health record. Services include

  • Management of chronic conditions
  • Management of referrals to other providers
  • Management of prescriptions
  • Ongoing review of patient status

Who can bill for CCM Services?

In a given calendar month, only one qualified healthcare professional who takes on the care management role for a beneficiary can bill for the CCM services provided to the beneficiary. Only the following professionals can bill

  • Physician
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant
  • Certified nurse-midwife

These non-physicians must be legally authorized and qualified to provide CCM in the state where the services are rendered.

How does the CCM Program help to increase revenue?

Getting paid for services already being rendered

As a primary care physician, you are already serving your patients with chronic diseases in many ways for no fees. Shifting to the CCM program now ensures that you get paid for these services. More than 67 million Americans are enrolled in Medicare Plans. And for eligible beneficiaries, a practitioner can bill an average of $40 for 20 minutes of CCM time per patient per calendar month.

Medicare provides coverage for practitioners to bill CPT 99490 ($42.23 in 2021) for the first 20 minutes that clinical staff spends performing CCM services in a month. You can then bill G2058 ($37.89 in 2021) for the second and third 20-minute increments. The total reimbursement for an hour of non-complex CCM services works out to $118.01, which can be a significant additional revenue for practices.

Getting paid on a recurring basis

Even if you are outsourcing CCM services to a qualified vendor because of resource constraints in your practice, you can be sure of recurring monthly revenue. As the CCM Program has been in existence for some years, vendors have had time to enhance the quality of their services. And so they can work as an extension of your practice. Patients are assured of complete care coordination and prescription assistance.

Hence, adopting the CCM program brings dual benefits of recurring income and no strain on staff resources.

Improved quality of care to patients

Without executing a quality CCM program, it is not possible for a provider to optimize the care of their patients with chronic illness. Quarterly visits may not be enough for a provider to understand a patient’s health conditions and make decisions to improve their quality of life. 

With the right program in place and with a qualified vendor, physicians can change the lives of their patients. Care coordination, monthly check-ins, prescription assistance, community engagement, and other factors assist your patients in attaining better outcomes in their well-being. The qualitative improvement in the health of your patients is bound to attract more patients to your practice leading to increased revenue.

How can Bristol Healthcare assist you?

Bristol Healthcare is a medical billing company serving the healthcare fraternity for over two decades. We serve our clients with commitment and ensure they receive superior services. Our mission is to see to it that our clients are reimbursed fully for the services they render in the quickest possible time.

Bristol is happy to serve you, whether for a single billing/coding service or the entire revenue cycle.

Talk to us for a mutually rewarding partnership!

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