In Medicare Chronic Care Management Billing, Payoffs from Patient Relationships

Tuesday, June 2nd, 2015
This post was written by Patricia Donovan

Up to 2,300 Arcturus patients may qualify for CMS's new Medicare Chronic Care Management billing code.

The numbers can dazzle.

Computing revenue potential from CMS’s new Medicare Chronic Care Management (CCM) code, Arcturus Healthcare estimated it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

And now, successfully billing Medicare for four enrolled patients, with more beneficiaries joining CCM rolls each month, Arcturus has discovered an added CCM payoff: the relationships forged with its patients.

“There’s so much value to this. Our patients just love it,” explained Arcturus’s Clinical Quality Assurance Manager Debra Burbary, RN, during a May 2015 webinar, “Medicare Chronic Care Management Billing: Leveraging Population Health Management for Successful Claim Submission,” now available for replay. “We have seen over the last year that our CCM work is creating one-on-one engagement with our patients. Patients really like the one-on-one attention. That relationship is what I really feel passionate about.”

While all Arcturus patients benefit from evidence-based care, the Chronic Care Management code allows the staff to extend much-needed chronic care services, Ms. Burbary added.

Arcturus is fortunate to have physician leadership supporting Chronic Care Management. “If you’re just starting with this process, you need to create within your group a physician buy-in for chronic disease management activities.”

Medicare Chronic Care Management is one of several programs for high-risk patients Arcturus has rolled out over the last year, including High Intensity Care Management (HICM) for patients with six or more chronic conditions.

Two CCM challenges Arcturus has encountered include the time and cost required to identify, document and track participating patients. Once patients enroll, Ms. Burbary estimates it takes at least an hour for a nurse to complete the initial assessment—beyond time spent with providers to obtain their goals for CCM participants.

“Remember, most of these patients are very complex. We’re identifying two chronic conditions that we want to work on with the patients, that we’re setting up goals for.” Between initial assessment and telephonic follow-up, Arcturus easily meets CMS’s requirement of 20 minutes of staff time per month per CCM patient.

Currently, Arcturus uses its Allcripts® electronic health record (EHR) to develop the care plans, patient goals, and progress-tracking mechanisms CMS requires for CCM billing. In the future, it may explore a remote monitoring feature built into its EHR.

With the potential for 2,300 Arcturus patients to meet CCM requirements, Arcturus has considered a smartphone app to further streamline CCM documentation, but acknowledges the technology could distance providers from their patients.

“If someone else follows our patients, we’re going to lose a little bit of that relationship, which we believe is very conducive to our success,” Ms. Burbary said.

During the 45-minute webinar, Ms. Burbary also shared the patient participation agreement Arcturus developed to address CMS’s seven requirements for CCM patient consent; patient response to the CCM co-pay; payment trends from secondary insurers, program expansion plans based on patient needs identified since CCM launch, and other program elements.

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