What is chronic care management software?
Chronic care management software is healthcare software created to help healthcare providers and their care teams manage the care of patients with chronic conditions. These software systems allows you to track patient health information, monitor a patient and their progress, communicate with patients and other healthcare providers, create and manage comprehensive care plans/ treatment plans, and provide care coordination.
Overall, a chronic care management platform can help healthcare providers improve the quality of care for patients with chronic conditions, create efficiencies in a practice, improve communication and collaboration between providers and their patients.
How much does care management software cost?
The cost of care management software can vary by vendor depending on the features and capabilities of the software, the number of users. Some vendors charge a one-time fee for the software, some charge a recurring subscription fee and others charge per number of patients on the platform. Additionally, some vendors include the implementation and training cost as part of the subscription/ license fee while others charge it as an additional cost or part of ongoing support. Based on the size of your organization and the features you would like to use and the integration capabilities needed, the cost of care management software can range from a few hundred dollars per month to several thousand dollars per month..
It’s important to carefully evaluate the features and costs of different care management software options before making a decision. You may also want to consider factors such as user-friendliness, compliance to make sure the full scope of services is completed before sending a claim to billing, scalability, and security when choosing a software solution.
Is chronic care management worth it?
Chronic care management (CCM) can be a valuable service for patients with chronic conditions. CCM provides ongoing care management and coordination to help improve health outcomes, quality of life and cut unnecessary health care costs. In order to determine if CCM is worth it for a particular patient or healthcare organization depends on a variety of factors.
Below are some of the potential benefits and considerations of chronic care management:
Benefits:
- Addressing co-occurring disorders: IBT recognizes that patients with substance use disorders usually have co-occurring mental health conditions, such as anxiety, depression or bipolar disorder. IBT focuses on addressing these co-occurring conditions simultaneously to improve treatment outcomes.
- Identifying high-risk situations and triggers: IBT emphasizes the importance of identifying high-risk situations and triggers that may cause substance use for the patient. By identifying these triggers or situations, individuals can learn better coping strategies and skills to manage avoid relapse or cravings.
- Developing coping skills: IBT focuses on helping individuals develop coping skills to manage negative emotions, stress, and other challenges that can lead to substance use. Examples of these skills could include cognitive restructuring, relaxation techniques, and problem-solving.
- Enhancing motivation: IBT seeks to motivate change by helping individuals identify their reasons for seeking treatment and setting achievable goals. By increasing the individual’s motivation they are more likely to stay involved in treatment and make long-lasting changes.
- Providing ongoing support: IBT understands recovery is an ongoing process needing ongoing support. IBT supports individuals throughout the recovery process and when treatment has completed.
Considerations:
- Staffing: Providing CCM services will likely require additional clinical staff, which can be challenging for some healthcare organizations.
- Cost: CCM services may come at a cost to some patients and will be an additional hiring, implementation, training, auditing and software costs for healthcare organizations
- Infrastructure/ Devices and Technology: CCM services usually rely on additional infrastructure/ hardware/ devices and technology, which can be expensive to implement and maintain.
- Patient eligibility: Not all patients may be eligible for CCM services, and those who are may need to meet certain criteria or enroll in specific programs the practice decides to offer.
Overall, whether or not chronic care management makes sense to offer to your patient population depends on a range of factors, including the specialty of the providers, if they manage any of the chronic conditions of the patients, healthcare organization’s resources and goals, and the specific CCM program being offered. For patients with chronic conditions, CCM can be a valuable service that can help improve health outcomes and quality of life, but it’s important to carefully evaluate the costs, benefits, and if it makes sense for what conditions the healthcare organization treats before implementing such programs.
Is chronic care management profitable?
Providing Chronic Care Management (CCM) services can be profitable for healthcare providers. Providing CCM services can be a profitable strategy for healthcare providers and allow them to generate a recurring revenue stream while improving patient outcomes and reducing healthcare costs through these non face-to-face services. It has been shown by providing ccm it has improved medication adherence and reduced hospitalizations and emergency department visits for patients. Additionally, providing ccm services can help to improve patient satisfaction and loyalty and attract new patients.
However, it’s important to note that healthcare providers should carefully consider the costs and resources required to provide CCM services and ensure that they are providing the required scope of services and billing appropriately in case of an audit.
How do I start a chronic care management program?
Starting a chronic care management (CCM) program can be a complex process, but here are some steps to consider:
- Patient Identification: Start by identifying the patients with chronic conditions.
- Determine program goals: Determine what chronic care management services you want to offer such as Principal Care Management, Chronic Care Management, Remote Physiologic Monitoring and/or Behavioral Health Integration.
- Choose a CCM platform: Choose a CCM platform that will allow you to efficiently manage patient data, track care activities, meets compliance requirements, communicate with patients and their caregivers and automatically code the services that need to be billed and drop the appropriate CPT codes into your billing system automatically.. There are many care management software options available, so be sure to evaluate your needs and budget carefully since specific care management platforms can allow you to bill a multitude of care management services when needed so it would make sense to pick a platform where everything can be done and integrated to the EHR and PM system.
- Develop a care team: Assemble a care team that includes healthcare professionals with the appropriate expertise, such as care managers, social workers, and care coordinators. Determine how the team will work together to provide coordinated care and what parts of the CCM platform they will need to learn and devise training for each role and user.
- Develop policies and procedures: Develop policies and procedures for your CCM program, including patient eligibility criteria, security and privacy criteria, and billing procedures.
- Train your staff: Ensure that your care team is trained on the CCM platform as well as the CCM program’s policies and procedures.
- Launch the program: Have CCM related marketing collateral such as brochures, posters, letters, call scripts to promote the CCM services to patients and their caregivers. Be sure to evaluate and monitor the program’s effectiveness regularly and make changes as needed.
It’s important to note that starting a CCM program requires a significant investment of time, resources, and expertise but once the Care Plans are signed off and patients are receiving recurring services the initial time requirement by the provider comes down and makes the provider and the healthcare organization much more efficient Therefore, it may be beneficial to partner with an experienced CCM vendor or consultant to help guide you through the process.
What does a CCM care plan look like?
A Chronic Care Management (CCM) care plan is a comprehensive document that outlines the patient’s chronic health conditions, treatment goals, and a detailed plan for managing the condition. The care plan is created in collaboration between the patient and their healthcare team, which may include their primary care provider, specialists, and other healthcare professionals.
A typical CCM care plan may include the following components:
- Patient information demographic and clinical information
- Chronic condition diagnosis list
- Treatment goals: The care plan outlines specific treatment goals that are customized to the patient’s condition(s), lifestyle, and preferences. These goals may include managing symptoms, improving quality of life, preventing complications, nutrition, and increasing exercise.
- Medications: The care plan lists all medications the patient is taking, including frequency and dosage, and may include any drug interactions and potential side effects.
- Care team: The care plan lists all members of the patient’s care team including primary care providers, specialists, nurses, authorized proxy and other healthcare professionals.
- Patient education: The care plan includes information about the patient’s condition and treatment options, as well as educational materials to help the patient manage their condition.
- Monitoring and follow-up: The care plan outlines a schedule for monitoring the patient’s progress, preventative service schedules, including frequency of regular check-ins, lab tests, and other diagnostic tests. Also, the plan may include strategies for follow-up and adjusting the treatment plan as needed.
Overall, a CCM care plan is a critical tool for managing chronic health conditions and ensuring that patients receive the best possible care. It provides a comprehensive plan for the patient and their healthcare team to provide connected care to achieving treatment goals and improving overall health outcomes.
Can you bill CCM if patient is in hospice?
No, healthcare providers cannot bill Medicare or other payers for CCM services for patients who are receiving hospice care.
How often can you bill chronic care management?
Healthcare providers can bill for chronic care management (CCM) services once per patient per calendar month.
Does CMS reimburse for chronic care management?
Yes, the Centers for Medicare and Medicaid Services (CMS) does reimburse healthcare providers for providing Chronic Care Management (CCM) services to eligible beneficiaries.
Is CCM for Medicare only?
Chronic Care Management (CCM) is not only for Medicare beneficiaries, and can be provided to anyone who needs these services, regardless of their insurance status.
While Medicare does have a specific program for CCM that provides reimbursement to healthcare providers who offer care management and care coordination for patients with two or more chronic conditions, CCM services can be offered by any healthcare provider to a patient with chronic conditions, regardless of their insurance.
Many private health plans and Medicaid have started offering similar programs that cover CCM services.
What conditions qualify for chronic care management?
For a condition to be defined as a chronic and qualify for chronic care management, according to CMS (Centers for Medicare and Medicaid services), the chronic condition is expected to last at least 12 months or until the death of the patient, and the condition must place the patient at significant risk of death, acute exacerbation/decomposition, or functional decline.
CMS maintains a Chronic Condition Warehouse (CCW) that includes information on 70+ specified chronic conditions. However, the CCW list is not an exclusive list of chronic conditions; CMS may recognize other conditions for purposes of providing CCM as long as they meet what is defined as a chronic condition.
Examples of chronic conditions that qualify for chronic disease management are as follows:
- Arthritis (osteoarthritis and rheumatoid arthritis)
- Asthma
- Atrial fibrillation
- Autism spectrum disorder
- Bipolar
- Cancer
- Chronic obstructive pulmonary disease (COPD)
- Congestive Heart Failure (CHF)
- Crohn’s Disease
- Depression
- Diabetes
- Hypertension
- Hyperlipidemia
- Infectious diseases such as HIV/AIDS
- Osteoporosis
How much does Medicare pay for CCM?
The reimbursement rate for CCM services is updated annually by the Centers for Medicare and Medicaid Services (CMS). These Medicare codes can be billed for non face-to-face care management services furnished to beneficiaries with multiple chronic conditions. For 2023, the reimbursement rate for CCM services per patient per month as per the national payment amount is as follows:
The average reimbursement per qualifying patient per month is $63 for CPT code 99490 for when the scope of services is completed between 20 to 39 minutes by clinical staff. Each additional 20 minute increment can be billed for $48 on average using CPT 99439 (max 2 units).
Feel free to take a look at CareVitality’s CCM calculator to understand what CCM services pay in your locale and get a good estimate of what you could be receiving annually based on your patient population. Please click here to learn more: CareVitality’s CCM Calculator is midway down the page.
Complex CCM codes require medical decision making of moderate to high complexity and establishment, implementation, revision or monitoring of a comprehensive care plan. When completing this service on average $133 for CPT code 99487 for 60 to 89 minutes and $71 for CPT code 99489 can be billed in addition for 90+ minutes.
This rate varies by locality and applies to CCM services provided to patients with two or more chronic conditions that are expected to last at least 12 months or until the death of the patient, places the patient at significant risk of death, functional decline, or acute exacerbation/decompensation.
Please note, there are certain CCM requirements to fulfill the scope of services before billing for these services, such as gaining patient consent, developing a comprehensive care plan, and providing at least 20 minutes or more of non-face-to-face care per month. Also, providers must use certified EHR technology to bill CCM services.
Who can bill for CCM services?
Under Medicare guidelines, a limited set of healthcare professionals are eligible to bill for Chronic Care Management (CCM) services. These professionals include:
- Physicians (M.D and D.O)
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Clinical nurse midwives (CNMs)
- Certified nurse specialists (CNSs)
Note: Primary care practitioners most often bill CCM services, but some specialty practitioners may furnish and bill them as well. CCM services aren’t within the scope of practice of limited license physicians and practitioners like clinical psychologists, podiatrists, or dentists, but CCM practitioners may refer or consult with these practitioners to coordinate and manage care.
To bill for CCM services, the healthcare professional must have an established relationship with the patient and be providing ongoing care management services. Additionally, the healthcare professional must meet certain requirements, such as providing at least 20 minutes of clinical staff time devoted to CCM services per calendar month, establishing a comprehensive care plan for the patient, and ensuring that the care plan is accessible to all members of the care team.
It’s important to note that private payers may have different guidelines and reimbursement structures for CCM services, and providers should check with each payer to ensure that their billing practices comply with payer guidelines.
Can an LPN do chronic care management?
Yes, LPNs can provide chronic care management (CCM) services to be billed under Medicare by physicians, nurse practitioners, clinical nurse specialists, and physician assistants who are licensed and authorized by the state to provide these services. Licensed practical nurses (LPNs) are not authorized to bill for CCM services under Medicare and are not licensed to put together comprehensive care plans since this is not within their licensure.
However, LPNs may be involved in providing some aspects of chronic care management services, such as patient education, vital sign patient monitoring, medication management, and coordination of care under the supervision of a physician or other authorized healthcare provider. The scope of practice for LPNs may vary by state and healthcare setting, so it is important to check with your state nursing board and employer to determine what tasks LPNs are allowed to perform.
What are examples of chronic care?
Below are some examples of chronic conditions that require ongoing management and care include:
- Diabetes
- Hypertension (high blood pressure)
- Hyperlipidemia
- Obesity
- Depression
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Coronary artery disease (CAD)
- Heart failure
- Chronic kidney disease
- Arthritis
- Dementia
- Cancer
Overall, integrating healthcare and public health can lead to improved population health, increased efficiency, health equity, cost savings, and improved communication and collaboration.
