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Chronic Care Management What do you need to know to Design and Implement Program

CMS began payment for Chronic Care Management in 2014, with multiple changes throughout the past 9 years ( adding more codes, adding a New concept u2013 Principle Care Management, increasing fees by ~50%). CCM has become a hugely profitable endeavor for many healthcare providers. Understanding compliance, knowing best practices, and starting off appropriately is essential for a Chronic Care Management program to be effective, compliant, and efficient. Register Now, https://conferencepanel.com/conference/chronic-care-management-what-do-you-need-to-know-to-design-and-implement-successful-program

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Chronic Care Management What do you need to know to Design and Implement Program

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  1. Chronic Care Management (CCM): What Do You Need to Know to Design and Implement a Successful Program Irina Koyfman, DNP, NP-C, RN CEO of Affinity Expert www.AffinityExpert.com Irina@Affinityexpert.com

  2. Learning Objectives 01 02 03 04 Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements Examine Scope of Services required to bill Medicare for CCM/PCM services Identify what is needed for successful plan Summarize Evaluation plan

  3. HISTORY of CCM 2015-Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with 2 or more chronic conditions. 2019 -CMS acknowledge that CCM services demonstrate increase in patient and practitioner satisfaction, as well as costs saving (CMS, 2019). 2021 -CMS made changes by adding Principal Care Management (PCM) code for a single disease and encourage providers to utilize more of the CCM services by allowing CCM to be billed in conjunction with the Transitional Care Management (TCM) (CMS, 2020).

  4. HISTORY of CCM 2022 CMS’s dramatically increased reimbursement to providers (~50%) AND Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill Chronic Care Management (CCM) and Transitional Care Management (TCM) services for the same patient during the same time period. 2023-FQHCs able to bill multiple times for CCM services using HCPCS code G0511, reflecting the increased complexity of care.

  5. WHAT IS Chronic Care Management

  6. CCM is the care coordination/care management that is happening outside of the regular office visit for patients with multiple (two or more) chronic conditions.

  7. Patients’ Eligibility Medicare patients with at least 2 chronic medical conditions that: Are expected to last at least 12 months or until the death of the patient; OR, – place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline

  8. Alzheimer’s disease and related dementia Arthritis (osteoarthritis and rheumatoid) Asthma Examples of Chronic Conditions Autism spectrum disorders Atrial fibrillation Cancer Chronic Obstructive Pulmonary Disease Cardiovascular Disease Depression Infectious diseases such as HIV/AIDS Diabetes Hypertension

  9. CCM Activities

  10. Physicians and the following Non-Physician Practitioners (NPP): Certified Nurse Midwifes Who can bill for CCM? Clinical Nurse Specialists Nurse Practitioners Physician Assistants RHC and FQHC Hospitals & Critical Access Hospitals

  11. limited license physicians and practitioners like: Who can NOT bill for CCM? Clinical psychologists Podiatrists Dentists Only 1 Provider can bill for a patient monthly

  12. Who can provide CCM If billing practitioner doesn’t personally furnish the services, the clinical staff furnish them under direction (general supervision) of the billing practitioner on an incident to basis

  13. Principal Care Management (PCM) PCM is provided for patients with ONE chronic condition - Specialist ( usually) A difference is that PCM has a time requirement of 30 minutes a month, verses CCM’s 20- minute requirement

  14. Benefits of Implementing CCM Financial – 100 patients on CCM can generate about $80,000 Improved patient and provider satisfaction (CMS, 2021) Improved patient’s clinical outcome • Study showed an improvement in blood pressure control (Hoehns et al., 2020) • Significant reduction in COPD hospital readmission was achieved (Press et al., 2021) • Stronger care coordination was achieved between PCP and specialists (Flieger et al., 2019) • And much, much more

  15. Pros and Cons of Outsourcing CCM PRO Con • Fast implementation • Less expensive (pay per performance) • No need to manage, just oversee • No need for platform and tech • Easily scalable • Less ability to manage the team • Less visibility of work • Depending on the vendor – less integrity • Providers are less engaged (enrolment and management) • Less collaboration

  16. Register Now

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