With the introduction of CPT 99490, the Centers for Medicare & Medicaid Services (CMS) has made it easier for your practice to capture new/recurring revenue for services that benefit some of your most at-risk patients—services you may already provide, but which were previously unbillable. In addition, offering these Chronic Care Management (CCM) services helps align your practice with various value-based reimbursement programs both now and in the future. If you are ready to offer CCM services, make sure you understand the requirements of the program and consider carefully whether to offer the service in-house or partner with one of the chronic care management companies that specialize in CCM.
CCM Benefits Your Patients and Your Practice
The CCM initiative is still relatively new, and if you aren’t yet familiar with the program, it’s worth learning more about. Chronic conditions are the most common health problem in the United States, particularly among Medicare beneficiaries. In 2015, CMS began offering monthly reimbursements to providers for services designed to help manage chronic conditions. These services are not those conducted during a face-to-face patient visit and have to meet specific requirements outlined by CMS.
The overarching goal of the initiative is to improve care and outcomes for those with chronic conditions by incentivizing providers to provide the services needed by patients with multiple chronic illnesses. Some of the benefits of a chronic care management program include:
- Better outcomes and quality of life for patients with multiple chronic conditions
- The chance for providers to capture revenue for services which they may already partially provide but have been unable to bill for
- A reduction in unnecessary costs for CMS
- Lower out of pocket costs for patients, including copayments, deductibles, non-covered services, and monthly premiums
In-house or Outsource to Chronic Care Management Companies?
If you would like to offer CCM to your patients, you may be wondering whether it makes sense to partner with one of the chronic care management companies that specializes in these services. The first step in determining the right option is to evaluate your practice’s readiness. Be sure to consider the following:
- Do I have enough qualified patients? CCM requires that the billing provider is the one managing two or more chronic conditions for a patient, and that only one provider may bill for CCM for that particular patient. Consider whether you have the numbers to justify CCM.
- Do I have enough staff? CCM services require clinical personnel, and you need to weigh the demands of CCM against your staff’s current workload. Don’t forget that you’ll need to provide patients with 24/7 access to and continuity of care, per CMS requirements.
- Do we have the necessary expertise? In order to successfully provide and bill for CCM, you must fulfill all program requirements, such as patient education, medication reconciliation, collaboration with other providers, etc. Make sure that you and your staff have an understanding of the program, and the ability to adapt to learn about and adapt to any future changes in program requirements.
- Do we have the right technology? There are several technology-related requirements for CCM which are not yet supported in many EHRs, including the ability to track time spent on CCM activities, collaborating with other members of the care team, and submitting CCM-related claims through certified EHR technology (CEHRT). Make sure you have the technology infrastructure needed to offer CCM.
- Factor in the overhead. After you’ve considered your staff and their bandwidth, your patient base, and the program requirements, review the costs associated with actually providing the service, such as additional payroll costs, dedicated phone lines, training for employees, and technology fees. Can you offer the service efficiently enough to turn a profit?
If one or more of these considerations would be a stumbling block for your practice, it may make sense to partner with one of the chronic care management companies that specialize in CCM.
What to Look For in a CCM Partner
If you decide to outsource to one of the chronic care management companies that specialize in CCM, look for a partner with the following strengths:
- The ability to provide end-to-end CCM services with appropriately licensed staff, including patient sign-up, care plan creation, care provided by nursing staff, and billing
- The ability to provide your patients with 24/7 access to and continuity of care
- A technology platform that supports and streamlines CCM activities, and which integrates well with your EHR
- The ability to seamlessly extend your care team, with a service tailored to meet the needs of your patients and clinical staff without disrupting your workflows.
If the chronic care management companies you are considering don’t meet all of these requirements, they won’t be able to help you meet the demands of a CCM program, Make sure to partner with a company that has the expertise and infrastructure necessary to help your practice successfully provide and bill for CCM services.
Partnering With BlueFish
BlueFish Medical provides an effective, efficient way for you to capture the benefits of the CCM program for your patients and practice. Our nursing staff, supported by our comprehensive technology platform, seamlessly integrates with your care team to offer all non- face-to-face CCM services. We lift the burden of providing CCM from your practice by providing end-to-end service, and free up providers to focus on face-to-face encounters, while also realizing reimbursements for non face-to-face visits to which they no longer have to dedicate their time.
In our experience, providers can expect to net around $36 per patient per month for CCM services. If a practice has 500 patients in their CCM program, the program could realize a reimbursement of $18,000/month, or $216,000/year. BlueFish earns a percentage of the reimbursement, and the practice gains the dual benefit of an improvement in the health of their patient population and revenue that it would not otherwise have generated.
If you’re looking for someone to partner with for CCM services, BlueFish can help you build a successful chronic care management program.