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Outsourcing Chronic Care Management Is a Win-Win for All!


The Centers for Medicare & Medicaid Services (CMS) has begun paying providers for delivering non-face-to-face care to their Medicare patients with two or more chronic conditions. This is a win-win for everyone involved in the process. Patients will experience improved outcomes and physicians have the opportunity to increase their revenue streams. CMS created the new CPT Code 99490 to reimburse providers for spending 20 minutes per month helping their patients manage multiple chronic conditions.

Medicare has traditionally only paid providers for care management services as part of face-to-face office visits. Now, eligible providers will be reimbursed at approximately $42 per qualified patient per month for these services. The Chronic Care Management (CCM) payment applies to both Medicare and Medicare Advantage patients.

Who is eligible for the new CCM payments? Providers eligible to bill Medicare for chronic care management include:

  • Physicians (regardless of specialty)
  • Advanced practice registered nurses
  • Physician assistants
  • Clinical nurse specialists
  • Certified nurse midwives (or the provider to which such individual has reassigned his/her billing rights)

The challenge for many physicians is that this follow-up care management and care coordination is very time intensive, and they simply do not have the professional staff bandwidth to provide this ongoing chronic care management.

The solution: outsource this function to a healthcare organization that is staffed with healthcare professionals who have extensive expertise in the care management of chronic health conditions.

Here’s how it works. The physician creates a specific healthcare plan for his patients and turns that plan over to the outsource organization who is responsible for the daily or weekly contact with the patient to monitor his or her progress, provide health coaching according to the physician’s care plan, ensure the patient is being compliant with the plan and report this progress to the physician.

This allows the physician to extend his chronic care management of patients by giving him the added professional staff bandwidth he needs.

Physicians have been providing care management for years; however, Medicare is now offering physicians the opportunity to bill for these services, providing a new revenue stream. By outsourcing the daily care management activities physicians can combine technology, clinical services and analytics that yield improved patient interactions between actual office visits, with almost no impact on their current professional staff. Outsourcing will allow the physician to increase and maximize patient enrollment in the program, increase patient compliance and provide CCM documentation requirements, while minimizing additional workload.

Outsourcing care management provides an end-to-end solution that will improve outcomes and provide increased revenue for the physician.

Physicians and patients working together to improve their health conditions is not a new trend in healthcare. Part of the CCM requirement includes the patient’s consent to encourage “program buy-in” with shared decision-making around the care management activities. Patients, who are compliant with their physician’s care plan, tend to be healthier and achieve better outcomes.

The communication between the outsourced organization’s professional staff and the patient is an extension of the physician’s practice. Additionally, ongoing interactions through personalized messaging motivates and supports patient’s to reach predetermined health goals set for them by their physician.

As a result, engaged patients are more likely to participate, adopt healthier behaviors and follow their physician’s care plan. The end result is higher quality of patient engagement, increased compliance, better outcomes, lower costs – and increased revenue for the physician.

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