CHRONIC CARE MANAGEMENT

Dec 12, 2019 | Call Center, HIPAA

Everything you need to know about Chronic Care Management and Oncology Care Model

CHRONIC CARE MANAGEMENT OVERVIEW

Chronic diseases are among the most prevalent and costly health conditions in the United States. The CMS estimates that over two-thirds of Medicare beneficiaries have at least two chronic conditions, and 14% of enrollees have six or more conditions. This 14% alone accounts for nearly half of total Medicare spending, that’s why it only makes sense that the agency sought to incentivize improved care for its patients with chronic conditions through the adoption of a set of Chronic Care Management (CCM) CPT codes.

WHAT IS CHRONIC CARE MANAGEMENT?

 CCM reimburses providers for non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.

Chronic Care Management is a step towards value-based care, along with practice and patient success.

HOW WILL YOUR PRACTICE BE PAID FOR PROVIDING CCM SERVICES?

Starting January 1, 2019, the reimbursable CCM codes are:

WHO IS ELIGIBLE?

PRACTITIONER ELIGIBILITY

Physicians and the following non-physician practitioners may bill for CCM services:

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants

However, only one health provider who assumes the care management role for a beneficiary can bill for providing CCM services in a given calendar month. While services are provided by a clinical staff person, the service must be billed from the list of practitioners stated above.

PATIENT ELIGIBILITY

Not all patients qualify for CCM services. Those who do should meet the following criteria:

  • Patient must have two or more chronic conditions.
  • Conditions are expected to last at least 12 months or until death of the patient.
  • Conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.

FEE-FOR-SERVICE VS. VALUE-BASED CARE

There’s an ongoing shift from fee-for-service moving rapidly towards value-based care. Implementing CCM can help practices generate additional revenue if conducted properly.

The Patient Protection and Affordable Care Act (ACA) of 2010 (also known as PPACA, ACA or Obamacare) has changed the way United States delivers health care itself. Its primary focus was to lower the costs of health care generally. Thus, the healthcare industry is experiencing a transformation involving reimbursement payment models. Medical providers must weigh the risks of fee-for-service versus value-based reimbursement carefully.

The transition from volume to value challenges major health care industry stakeholders to prioritize higher quality care while simultaneously increasing their clinical and administrative efficiency.

ONCOLOGY CARE MODEL (OCM)

With more than 1.6 Million new cancer cases every year, cancer diagnoses comprise some of the most common and devastating diseases in the United States. Through OCM, The Center for Medicare & Medicaid Innovation (CMS Innovation Center) has the opportunity to achieve three goals for the effective care of this medically complex population:

  • better care
  • smarter spending
  • healthier people

The CMS Innovation Center is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care.  Oncology Care Model is one of those specialty models, which aims to provide higher quality, more coordinated oncology care at the same lower cost to Medicare.

OCM is a five-year model that began in July 1, 2016 and runs until June 30, 2021. It uses an episode-based, two-part payment approach: monthly care management payments (i.e., Monthly Enhanced Oncology Services [MEOS] payments) and potential retrospective performance-based payments (PBPs) based on lowering episodes’ total cost of care. Each episode is six months in duration and is triggered by the receipt of either oral or intravenous (IV) chemotherapy.

PARTICIPANTS AND PRACTICE REQUIREMENTS

HOW CAN VISAYA HELP YOU?

The aging and growing populations plus the significant rise of people living with chronic diseases are just some of the factors why Healthcare is one of the highest growth industries in the world. Healthcare employment is expected to continue its steady growth to reach almost 26% by 2022, according to the Bureau of Labor Statistics.

Alongside this significant growth are the bigger challenges of keeping up with the demand for improved quality of care and better patient outcomes while reducing costs. That’s why increasing numbers of healthcare organizations and service providers have turned to outsourcing to meet these needs.

Visaya’s Chronic Care Management team is composed of highly competent and experienced Health Information Technicians who are AAPC and/or AHIMA certified. They are also board certified MDs, RNs, LPNs and LVNs. They work as an extension of your internal staff to manage CCM patients. Our highly trained nurse navigators will be your patients’ guide through their chronic care journey. They act as a one-on-one contact person that educate, advocate and communicate so that patients and families understand their treatment options with the goal of achieving better health outcomes.

We at Visaya understand the importance of addressing and preventing care gaps, both in terms of the health outcomes and revenues, that’s why we deliver the utmost care and provide services that will be most beneficial to the patients while reducing costs both for the patients and the ACOs alike.

Under Visaya’s Healthcare Information Management services, we customize healthcare solutions that can surely help ACOs and providers alike in lowering down their costs, increasing the quality of care and achieving better patient outcomes.

  • Patients Eligibility Identification
  • EHR Integration & Customization
  • Patient-Centered Care Plan
  • Patient Outreach
  • Patient Engagement
  • Efficient Patients Enrollment
  • Monthly Care Coordination
  • 24/7 Care Support
  • EHR Documentation

Let Visaya be an extension of your CCM practice. Message us now at info@visayakpo.com