Chronic Care Management
When your patients reach age 65 and become Medicare eligible it is a milestone in more than the time in life when they move from private health insurance to national government sponsored healthcare. Age brings with it new health issues that require an increased awareness and focus on prevention and health maintenance. Where once staying in shape seemed almost effortless, now a one or two week lapse in exercise can see major decline in conditioning. The majority of people who reach old age have one or more health impacting issues like high blood pressure, heart disease and or diabetes. Dietary habits have caused people to gain weight which impacts health.
As people age into their seventies and older they experience exacerbating chronic disease, acute episodes, take more medication and experience decline in their health and function. All of these factors increase their health costs, including emergency room and hospital stays.
Older patients benefit from care coordination for chronic illnesses according to studies done by CMS, the Rand Corporation, and others. Coordination and continuity of care generally mean the patient will be overseen by a primary care team who has a relationship with the patient. The patient is likely to see fewer providers and need fewer and less costly services.
CCM ( CPT 99490, 99487,99489)
Recognizing both the potential patient health benefits and cost savings, CMS has created a reimbursement codes (99490, 99487, 99489)) and a requirements frameworks for Chronic Care Management (CCM). The reimbursement fees established for 99490 (about $40 for 20 minutes of non-office visit staff time to $209 for the initiating visit) enable a typical primary care practice to generate substantial new revenue, and if done efficiently can increase significant new net income.
There are a number of challenges in implementation of a profit making CCM program. The obvious threshold requirement for implementing a CCM program is the ability to assemble the necessary information systems, service protocols, and trained CCM staff to do the work and documentation required for reimbursement. Beyond this, however, there are several not trivial challenges to the clinical and financial success of a CCM program. Some are inherent in the CCM program itself and one is unique to independent primary care practices.
Patient Consent and Patient Co-Insurance.CMS requires a written consent for CCM services from the patient, in advance, for any month in which CCM services are charged to CMS. This can be in the form a ‘standing” consent,but it can be withdrawn at any time. In addition, CMS requires the patient to pay 20% co-insurance (about $8) on any 99490 billed service. The practice will have to have a “marketing program” for obtaining these consents. (Time spent in obtaining consents is not reimbursed.) Patients will have to be billed for co-insurance charges.
The 99490 Reimbursement Standards. CMS only pays for 20 minutes of CCM qualified services per calendar month regardless of what the patient may actually need and receive. If these services aggregate less than 20 minutes in a calendar month then none of it can be billed. If more than 20 minutes then the extra time will not be paid for. Time does not carry over month to month.
Maximizing CCM Revenue without Being Unethical and/ or Irritating Patients
CMS has created a practical tension between delivering to patients the “CCM services they need, when they need them, in the way the need them” and the risk that all service time rendered above and below the 20 minute standard will not be paid for If patients are forced to spend time on,and receive bills for,services they do not value, they will opt out, and the CCM program will fail. The key to success are services perceived by senior members of your practice they value.
Practice Size and CCM Program Economies of Scale.An efficient, properly trained CCM Staff FTE equipped with good workflow support systems will have capacity to serve far more CCM service demand than one primary care practice can generate. This means the best (and only real) option for independent primary care practices is to purchase CCM program support as a turnkey service.
The MDCommerce SeniorLineServices Business Model For Primary Care Physicians
While the Medicare Chronic Care Management model focuses on care coordination for dual diagnosis patients, the MDCommerce business model is to recognize your older patients all face new health challenges, and as their primary care doctor you can’t respond to their needs including coordination of care in the same way possible when those same patients were younger. Rather than segmenting out the dual diagnosis patients Seniorline is inclusive for all older patients and offers a package of specialized services to all seniors 65 and older. By creating a membership program of targeted services designed to help seniors manage their health needs through customized prevention and health maintenance services you can afford a relational care program for each patient. By meeting the needs of each patients status you also create new revenue streams including CCM fees for eligible patients.
The MDCommerce team has over 20 years’ experience in providing physicians with off site Gold Standard RCM services, staff extension services, cloud IS, and telephone based care coordination support.
SeniorLine Can Increase Practice Revenue By $85,000-$125,000
Our IT platform plus 24 X 7 medical assistant and care coordination support for patients makes possible a whole new steam of revenue from $85,000 to $125,000 per year that will increase your net take home income above costs by $40,000 to $50,000 per year.
The MDCommerce integrated staffing model enables you to launch a new Seniorline program without adding new in practice staff of disrupting your practice IT systems or workflow.
Get Started Now
with a free practice analysis to explore the appropriateness of Seniorline Services for your patients and discuss how you can implement SeniorLine with Chronic Care Management. Call 888-339-9504.