iPatientCare Blog - Getting paid for CCM 2019

Getting Paid for CCM 2019 – Not as difficult as you think

Chronic conditions come at great expense to both patients and the healthcare system. The most common chronic care conditions found among Americans are – Alzheimer’s, arthritis, breast or colon cancer, COPD, diabetes, hypertension and many more. Some of these patients suffer from more than two or three of these long-term illnesses.

Advantageous for Primary Care Providers too

Many primary care providers see a number of barriers to entry and sometimes hold off actually implementing chronic care management. The Centers of Medicare and Medicaid Services (CMS) established a process for CCM that improves patients’ lives through more frequent interactions with the healthcare professionals and to encourage the overall process for documenting the chronic care management through certified EHRs, the providers can be eligible for some additional incentives.

The care coordination, text or phone, medication management, and 24/7 accessibility are some of the services Chronic care management provides outside regular face-to-face appointments. The practices and their patients can start to benefit from this by using the right kind of tools in place. There are some chronic care management trends that every healthcare organization should pay attention to.

Recent changes affecting the Chronic Care Management

  • The practices that invest in comprehensive care management platforms to help their administrators see visible progress in advanced administrative abilities, like controlling system permissions and providing an easy-to-use interface. This supports administrative staff for future growth.
  • The provider can provide a standard enrollment workflow that confirms that the patient has two or more eligible chronic conditions and then recommend participation in the CCM program during a face to face visit, where patients need to provide verbal consent to enroll.
  • Value-based care is driven by data as opposed to fee-for-service models. The providers must be able to track and report everything from readmissions to population health, and also patient engagement. For this, the providers must use specific metrics which must be accessible to all, as any healthcare professional know how difficult it is to work with data that is incomplete, fragmented, and difficult to access. There will be more focus on gathering, protecting, and analyzing data when the proper data is provided.
  • Therefore, must develop processes for ongoing implementation. Chronic care management requires providers to schedule monthly out of office visits, which includes 20 minutes of care via email, text or phone. After each interaction, the provider must review and update the patient’s care plan and inform them if any changes are made.
  • As the data comes from various source such as different departments, different groups, etc., sometimes there can be a problem with data interoperability. Providers must have access to a patient’s past data for chronic care to be effective. Without this history, providers cannot avoid gaps in care, or ensure a smooth transition of care.
  • This is why data interoperability is vital as it can identify the areas for improvement, scheduling staff members and act on connections that might not be highlighted before. One of the focuses in 2019 is improving this data interoperability, so that all the providers, specialists within the healthcare’s ecosystem will have access to comprehensive individual and hospital-wide area.

All the assistance you need is available

The chronic care management payment requirements may be overwhelming and confusing to solve, for this reason, there are EHRs like iPatientCare that simplifies this process and ensures that your practice is properly involved. iPatientCare Cloud-Based Psychiatry EHR also ensures that proper documentation for patient visits with chronic care conditions is done and required reports are available. The claims for chronic care management must be filed every month. The reimbursement in 2019 will require an increasing reliance on data from primary care practices proving to payors that they are meeting performance measures. In the future, the reimbursement models will become more complex and will also involve more and more measures, and so it is important to have reliable vendors like iPatientCare for guidance and support.

Further Changes Made by CMS

CMS may be adding new codes for remote consultation that the providers might miss out in 2019 if they do not focus on codes that already exists for chronic care management. Wellness visit is also another lost opportunity in Medicare. It is best to capture all the reimbursement successfully, by completing all the overdue for appointments.

Must appoint someone in charge to take care of hospital/practice, and documenting what is important for the care management codes because as mentioned earlier, data becomes increasingly important for practices’ reimbursements. Even if the services are provided by practice’s staff person, the service must be billed under clinical nurse specialist, nurse practitioner, physician assistant, certified nurse or the physician.

The healthcare common procedure coding system compensates providers for the extra time and effort it takes to initiate CCM with a patient. It includes comprehensive assessment and care planning for patients requiring chronic care management services. New codes are permitting providers to bill for thirty minutes of chronic care management services.

A very handful of EHRs like iPatientCare is designed to support chronic care management work. Pushing for improvement in patient care, can help healthcare organizations to improve everything from administrative efficiency to patient engagement, and will continue to do so for the year 2019.

Shifting from episodic care is not a new concept, chronic care management is just a CPT-based alternative to being part of an alternative payment model. It is crucial that providers lead and embrace the comprehensive approach to patient care. As the healthcare system transitions from a fee-for-service model to value-based payment, billing chronic care management services make it possible for you to be paid for the time and effort you and your team has invested in caring for your patients with chronic conditions.

The practice must opt for chronic care management, by applying the above tips that can significantly increase Medicare reimbursements for the majority of your patients. This step will not only help them in improving their health or managing their conditions but also will benefit the fiscal health of your practice.


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