Bill a New series of CPT Codes
One of the first activities we will do on your behalf is to analyze Medicare History for your provider population, to quantify the volume of CCM Program CPT codes. Most of the time, we find that these codes are not being billed at all. These codes support billing for monthly telehealth activity with each Chronic patient, by approved mid-level providers. Bottom line: If you are not billing these codes, you may be caring for Chronic patients, but you are not taking advantage of the Medicare CCM Program.
Patient Onboarding program is the key
The Medicare CCM Program requires that patients: a) have one or more pre-defined Chronic Conditions; and b) have explicitly opted-in to the Medicare CCM Program.
Achieving this opt-in requires a dedicated activity. If you have an organized outreach program, supporting technology and dedicated staff you can expect to opt-in up to 40% of eligible patients. Practices who enroll patients as a part of office visits alone can expect opt-in volumes closer to 4%.
Physician involvement
Medicare has configured their CCM program to improve physician leverage. Physicians must discuss CCM with a patient during an "initiating visit", which can be any face-to-face Evaluation and Management (E/M) visit, Annual Wellness Visit (AWV), or Initial Preventive Physical Exam (IPPE).
The physician will also want to collaborate with the mid-level provider who configures each patient's care plan. And the mid-level must be working under the direction of a physician - which is not required to be in person or face-to-face.
Once these processes are accomplished, the monthly patient interaction only requires physician involvement at the discretion of the Care Manager.
Mid-level providers carry the load
One of the primary benefits of Medicare's CCM Program is that patient care and its associated billing do not require regular physician involvement. Most Care Managers are certified as CNS, NP, or PA. When using a dedicated software tool, these mid-level practitioners follow Care Plans, document monthly clinical observations, and automatically support billing under the CCM CPT Code set.
These Care Managers do not even need to be employees of the billing clinic. They can be employed by the ACO (or other third party), and simply re-assign their Medicare Billing rights to the TIN where the patient relationship resides.
Efficiency is important for success
Nursing staff is expensive. While Medicare Reimbursement does a good job paying for these services, a CCM Program is a high-volume activity.
On average, Care Manager reimbursement applies in 20-minute segments. Here are a couple metrics: an 8-hour day consists of 24 of those 20 minute segments. A week contains 120 segments and a month of 20 working days results in 2,400 segments. So in theory, one Care Manager could handle 2,400 patients. Of course, that assumes 100% efficiency which is clearly unachievable. The goal of CCM software and protocols then, is to strive for continuous improvement in efficiency.