How to Get Paid for the New Chronic Care Management CodeIn spite of new CMS payments available to physician practices for chronic care management (CCM) services, almost half of healthcare organizations have yet to launch a formal chronic care management program, leaving critical reimbursement dollars on the table, according to a recent survey by the Healthcare Intelligence Network.

The survey showed that almost 45 percent of respondents have yet to bill for the chronic care management code, missing out on at least a portion of the $300,000 per year in additional revenue experts estimate the program will bring to the average practice.

CMS’ chronic care management program launched Jan. 1, 2015, and provides reimbursement of $42.60 per patient per month for non face-to-face care for patients with two or more chronic conditions. Additional requirements make setting up, tracking and billing for the program time-intensive without software designed to support the program.

The delay in implementation is not due to a lack of belief in the underlying premise. The survey showed that 77 percent say CCM programs have improved self-management levels in enrolled patients. And almost half—46 percent—say CCM has decreased hospitalizations in the population served by the program.

In addition, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt private payors to offer similar reimbursement for quality programs, emphasizing the importance of care coordination in a value-based healthcare system.

The survey found that just over one-third of respondents—35 percent—are currently reimbursed for activities related to CCM.

Why the Lack of Adoption?

We suspect that the biggest factor in the delay of adoption of chronic care management programs in practices is the fact that most EHR software packages are not designed for tracking, managing and billing for the patient care required. Manually tracking and managing the patient load for this program is onerous and could quickly consume most or all of the revenue generated by the program.

Only one EHR, MediTouch, currently offers a chronic care management software feature, with most other options being stand-alone software that must be integrated with existing software—always problematic.

Best of all, MediTouch not only offers the chronic care management feature, but it’s included in the software at no extra cost.

The MediTouch chronic care management software feature:

– Provides an interface that creates a virtual list of all your patients that have FFS Medicare and at least 2 chronic conditions

– Narrows that list of patients “real-time” to ones that:

– Have had activity outside of an in-person or telemedicine encounter with the patient

– Have a signed CCM patient agreement incorporated into the medical record

– Creates bills easily each 30-day period with the new CPT code for every patient that meets the first 2 conditions.

– Tracks whether the code was already billed during the 30-day period

– Reminds you to bill the service when appropriate before the billing period expires.

For more information on the requirements of the chronic care program, download our free white paper today. To see live how the MediTouch chronic care management feature makes the program easy to implement and manage, request a free online demo now.