Four Tips to Get Ready for a Chronic Care Management Program

Everybody’s talking about Chronic Care Management (CCM) and for good reason, though many people admit they don’t know much about the details. The Centers for Medicare & Medicaid Services (CMS) created CPT code 99490 in order to reimburse providers for delivering non face-to-face, in between-visit care coordination services to eligible Medicare patients with two or more chronic conditions. However, with new programs often comes some skepticism and fear.

There are some providers who think that the additional staff they would have to hire to implement the program and ensure its compliance will ultimately cost more money than the reimbursement is worth. However, there are many practices that have seen the benefits of starting a CCM program, including significant recurring revenue and improved care for patients.

If you decide that CCM is right for your practice, and that the financial benefits are worth making some minor changes, there are initial steps you can take to get your practice ready for CCM and implement CPT Code 99490. 

1. Take the temperature of your practice. It’s important to take a good look at how your practice truly cares for patients and their records. What kind of coordination are you implementing now with the other providers your patient sees? What kind of EMR and technology do you use? What does your admin and care team look like? Do you have the resources available to meet CCM requirements and start a CCM program?
2. Use CCM as a springboard toward patient-centric care. Today, many providers plan their days based on patient-scheduled appointments. It’s a reactive approach. In order to grow with the future of healthcare it is important to migrate toward more proactive appointments that provide value and regular contact with patients, their other providers, and even their caregivers. Many forward thinking practices provide patients with a full health summary that documents everything from past medical history and hospitalizations, to allergies and medications from all of their providers. This information can not only help patients move through the appointment process more efficiently, it will also ensure that they are receiving complete care. With access to care plans from other providers, there is no duplication of tests or issues with drug interactions the patient may have forgotten to tell you about.
3. Get a second opinion; hire an expert. Like internists who refer patients to cardiologists, sometimes people need to rely on a specialist to get the job done. CPT Code 99490 has requirements providers need to meet in order to bill and remain compliant. Talk to an expert in the CCM field who knows it inside out and can help you weigh the options of starting CCM in house versus working with a partner. A partner could do all the heavy lifting (software, support staff, billing, nursing services) while the practice reaps a sizeable monthly reward. Regardless of how experts are used, at the very least they can help you build the framework for a new CCM program quickly and efficiently.
4. Evaluate your technology. Still on dial up? Hope not. Seriously, the thing that needs to be a priority in a thriving practice is the use of  an IT infrastructure that can make the practice work more effectively by gathering and recording all of the information needed to bill for CPT Code 99490. The data gathered and stored on patients help the practice provide complete care and bill for CPT 99490 with confidence, every single month. Old technology costs more time and money to run it than people think, so upgrade sooner than later and reduce your administrative hurdles.

CCM is complex, no doubt about it. Starting with these four steps could help your practice turn from old and ineffective workflows toward the new migration of Medicare’s Chronic Care Management program. Since any provider can bill only once per patient per month for CCM, there will be some who bravely reap the new revenue rewards and others who completely miss out. The big shift to value-based care is going to change the future of healthcare by reducing inefficiencies and finally providing improved healthcare for patients with chronic conditions. Your next step with CCM is simple. Get on board or get left behind.