MEDICARE CCM PROGRAM & WHY DO PHYSICIANS PREFER TO OUTSOURCE IT?

The burden of managing patients with chronic conditions has always been a concern for CMS. The number of Medicare beneficiaries is projected to reach over 30 million by 2030, which is around 54 million as of 2018.  Currently 2/3 of Medicare population is having multiple chronic conditions. Federal data suggests that more than 85% of healthcare spending is on managing chronic conditions such as diabetes, arthritis, hypertension, kidney and cardiac disease. Slowing the rise on healthcare spending has been one of major priority and there have been numerous policies implemented to put tab on the excessive spending.

After careful consideration on January 1st, 2015, CMS introduced a Chronic Care Management Program that encourages physicians to bill for non-face to face in between office visit encounters for the eligible Medicare enrollees who have two or more chronic conditions that are expected to last for more than 12 months, and put patients at the risk of death or functional decline.

CMS introduced this program to reimburse providers for providing care management services to patients for spending at least 20 minutes over the phone per calendar month. The Center for Medicare and Medicaid Services (CMS) weighs Chronic Care Management as a fundamental component for primary care and require the healthcare professionals to create a coordinated care plan among the caregiver, patient, and his/her family members to reduce the onset of any unexpected healthcare complications that can lead to serious ailment.

Medicare has introduced CPT 99490 that reimburses eligible providers and healthcare professionals $42 on average for providing non-face to face care coordination. However, only one provider can bill for CCM services once per calendar month.

The primary goal is to improve access to Chronic Care Management for Medicare beneficiaries in order to reduce hospitalizations, improve patient experience, and help patients stay healthier. Many physicians started taking advantage of this opportunity by initiating CCM Program to generate additional revenues from their existing patient base. However, there are implementation complications that prevented many eligible providers to take advantage of this plan.

(Outsourcing help Physicians to initiate CCM program with minimum efforts)

Why Physicians Find It Convenient to Outsource CCM?

According to CMS guidelines, the physicians can initiate the Chronic Care Management Program themselves, or a healthcare professional can provide the care management services under the supervision of the eligible provider.

CMS statistics have shown that the physicians are still struggling to implement the Chronic Care Management Program, thus giving up a huge opportunity to claim CCM revenues. Physicians were finding it hard to meet the patient engagement, unending compliance modifications, patient education, and technological advancements that are all major components of coordinated care. However, physicians find it convenient to outsource CCM.

Once CCM services are outsource, the physicians do not have to add additional office staff. This reduces the administrative burden and overall overhead cost on a practice. It also allows the office staff to focus on their day to day tasks. According to a rough estimation, an individual practice can earn up to $500 in annual revenue per eligible Medicare patient without investing on technological improvement.

Physicians Revenue Group, along with its partner, gives an opportunity to outsource CCM services to PCM-Passionate Care Management. PCM provides an all-inclusive method for tracking and billing for CPT codes and will integrate with the necessary technology in providing features essential for CCM. PCM-Passionate Care Management provides end to end solution that enable physicians to facilitate CCM required activities using their turn-key solutions from patient registration to billing.