Keeping your business as healthy as you keep your patients.

Chronic Care Management: Do it yourself? Contract with a Service? Not enough reimbursement to bother?

OF COURSE you want to keep your at-risk patients healthier by tracking them between visits, but that only works if you can do so economically and with as little management effort as possible. Perhaps you are already spending copious unpaid time on the phone managing care between office visits. For patients with two or more chronic conditions, CMS will reimburse for monthly check-in, monitoring, and coaching done by phone and by nurses and others besides physicians. (Click for detailed description of what CMS considers reimbursable Chronic Care Management.) But claim payments for these services are low, and it is very difficult to deliver them economically yourself.

Three levels of help are available:

    • License CCM support software and do it yourself (Many of the EHRs have available CCM modules)
    • Partner with a CCM Case Management Company. These third parties will do most of the work, but most use their own system which you’ll need to learn and access
    • Partner with a Full Turnkey case management company

Do it yourself: Doing it yourself, even with the aid of optimized software, is still administratively complex. The software is inexpensive, but unless your practice manager and staff have time on their hands, you will spend most if not all of the reimbursements on your nurses delivering the service and on managing them.

Partner with a CCM Case Management Company: These third parties manage their own nurses, CMAs and CNAs who will make calls to your patients to coach and monitor their status, and keep them engaged in their own health. They will track the time spent and patient adherence to the care plan, and will update the care plan if warranted. They operate as extensions to your own staff and services are billed ‘incident to’ the physician’s involvement. (Use of these companies IS approved by CMS.)

The notes are available to the practice and a monthly summary of all patients served is also available. Additionally, some will take calls 24/7 from the patient or caregiver with questions and they triage care – if escalation is needed they will notify the physician or practice according to protocols established by you. Some of these will also submit the claim. Your practice is reimbursed directly as with any other Medicare claim, and then the third party is paid for their portion of the service.

Most of these keep the CCM notes in their own EHR, accessible to you only by logging onto their portal. Essentially, you (and your staff) need to learn to access and navigate an additional (even if simplified)EHR! If the management company submits the claims themselves, that creates another problem: Without the encounters being present in your system, denial management, tracking of co-pays or co-insurance, and eventually patient responsibility requires a completely different workflow. For many practices, this results in promised revenues left uncollected.

Go Full Turnkey: The difference between most case management offerings and a Full Turnkey solution requires these extra steps: the notes must be pushed into your own EHR, attached to the patient’s chart, and each patient’s monthly CCM ‘encounter’ is also entered in your EHR. Your patients’ CCM/RPM notes will be in the same place as the rest of their chart, and your billing flow (whether internal or contracted) will see and process CCM/RPM claims as with any other encounter. You will not need to learn or access another system. But be careful: Many solutions claiming to be full turnkey can only achieve this if you use one of a limited set of EHRs. Still, there are workarounds.

For most practices, Full Turnkey is the way to go!

This is the first in a series of articles about Chronic Care Management (CCM), and the closely related Remote Physiologic/Patient Monitoring (RPM). Others in the series will be:

What is Chronic Care Management?

Service Quality matters with outsourced CCM

Considering Remote Physiologic/Patient Monitoring (RPM)? Here is what you need to know!

How to select an outsource partner for CCM and/or RPM services

You CAN deliver CCM services in Nursing homes – according to CMS!

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