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medical billing in chronic disease

The US government has been a stern supporter of chronic disease management programs. On the same side, it scrutinizes medical billing in chronic disease management. Suppose you are a provider offering chronic disease management services. In that case, it is essential that you appropriately follow the rules when it comes to medical billing services for chronic care management. Furthermore, you can expect more audits to investigate the core causes of overpayments, which are associated with incorrect billing of the services.

Starting Medical Billing in Chronic Disease Management Process

Medical billing process for chronic care management involves many vital steps including: 

  •  Ensuring effective care coordination
  • Accurate billing
  • Efficient patient outcomes. 

Below is an overview of how the process normally works:

1. Identifying Eligible Patients

Medical providers need to identify patients suffering from chronic diseases and determine who can benefit from medical billing in chronic disease management. Such patients often have multiple chronic conditions that necessitate continuing care and support.

2. Developing a Complete Care Plan

A dedicated care team comprises nurses, physicians, and other healthcare professionals. Together, all of them can create a complete care plan customized to an individual patient’s needs. Such care plans include interventions, goals, patient education, and medication management.

3. Consistent Communication and Follow-Ups

A care team conducts consistent follow-ups and check-ins with patients, either through telehealth services or in-person, for better access:

  • Health status
  • Addressing concerns
  • Facilitating ongoing care team and patient engagements and more for effective medical billing in chronic disease management services.  

4. Managing Medication

Care teams also monitor patient medication adherence, furthermore adjusting prescriptions as per requirements, and even ensuring proper medication management. All of this helps prevent adverse drug interactions and further optimize the effectiveness of treatment.

5. Self-Management and Patient Education

Educating your patients empowers them to manage their chronic conditions effectively. The care teams can offer patients resources, guidance, and continuing support to help them understand their conditions, make lifestyle modifications, and easily comply with treatment plans.

Understanding Chronic Care Management (CCM)

Now that you have some idea about medical billing in chronic disease, let’s understand CCM a bit further. Chronic care management entails proactive and continuing care offered to patients suffering from chronic illnesses, including but not limited to heart diseases, diabetes, and COPD.

Chronic conditions mostly call for:

  • Comprehensive care plans
  • Effective coordination among healthcare providers
  • Regular follow-ups

Chronic care management optimizes patient care by forming an out-and-out care team, encouraging patient engagement, and leveraging technology for efficient data management and communication.

Qualifying Patients for Chronic Care

Patients with two or more chronic conditions can qualify for reimbursable care under the relevant CPT codes. To qualify for CCM, the patients must be a risk of:

  1. Organ failure
  2. Death
  3. Worsening conditions
  4. Functional decline

Furthermore, their conditions are expected to last at least 12 months or until death.

Important Benefits of Chronic Care Management

The core benefits of CCM and medical billing in chronic disease management offer the following benefits:

Preventing Gaps in Treatment

Often, patients suffering from chronic diseases present with gaps in their care. Reasons include:

  • Disorganization
  • Poor communication
  • Failure on the provider’s end

For preventing such gaps in treatment, chronic care management programs help avoid gaps in patient care. The CCM program ensures that someone from the patient care team touches base with patients at least once a month. It is done to ensure that patients are on track to receive the best health outcomes possible.

Improving Health Outcomes

By ensuring that someone from the patient care team is keeping them accountable for their care plans, patients are likely to achieve better health outcomes. The care coordination experts are available to patients to answer all questions. Furthermore, effective care coordination also helps patients keep track of their medications and alerts providers of new developments or even red flags in their care program. Patients under CCM can expect to achieve better health outcomes and results by streamlining all the moving parts working together.

Final Word

Healthcare professionals can expect a significant boost in their practice revenue by offering chronic care services. Practices offering CCM can earn a considerable amount per billing provider in their organization every year. Outsourcing medical billing in chronic disease management can help your practice optimize patient care and ensure optimal revenue. Third-party medical billing services providers work alongside your practice to ensure patients get the best help.

Frequently Asked Questions

The billing codes for CCM include the following CPT codes:

  • 99490/99439
  • 99491/99437

Ongoing treatment for chronic diseases can be coded for reporting as often as the patient receives treatment for their condition(s).

The PCM involves treating patients with one complex chronic condition, while CCM patients have two or more chronic diseases.

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