Description

CMS began payment for Chronic Care Management in 2014, with multiple changes throughout the past 9 years (adding more codes, adding a New concept – Principle Care Management, increasing fees by 50%). CCM has become a hugely profitable endeavor for many healthcare providers.

More vendors are coming to the “playground” with their software, clinical teams, and billing capabilities. Providers must be more vigilant in choosing CCM vendors because the billing is always done under providers making them accountable for everything the vendor is doing. Understanding compliance, knowing best practices, and starting off appropriately is essential for a Chronic Care Management program to be effective, compliant, and efficient.

Learning Objectives:

• To verbalize key component of CCM
• To summarize evaluation plan
• To identify what is needed for the Implementation Plan
• Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements
• Examine the Scope of Services required to bill Medicare for CCM services
• Identify how CCM can close care gaps and engage patients
• Assess the financial and quality implications of incorporating CCM in your practice
• Recognize the importance of CCM in relation to quadruple aim

Areas Covered in the Session:

• History of CCM
• Sobering Statistics
• What Is Chronic Care Management
• CCM Activities
• Patients Eligibility
• Examples of Chronic Conditions
• Provider Responsibility
  • Face-to- Face Visits (within 12 months)
  • Consent
  • Establishing, Revising and Providing pt with a Comprehensive Care Plan
  • Designated care team member
  • Certified EHR
  • 24/7 coverage
• Initiating Visit
• Consent
• Consent Template
• Comprehensive Care Plan
• Billing
• Who can bill for CCM?
  • Physicians
  • Certified Nurse Midwives
  • Clinical Nurse Specialist
  • Nurse Practitioners
  • Physician Assistants
  • RHC and FQHC
  • Hospitals & Critical Access Hospitals
• Who can not bill for CCM?
• Who can provide CCM?
• Clinical  Staff
  • CPT Definition
  • CMS  Definition
• Bonus Codes for Specialists
• Know the Rules
  • Transitional Care Management (CPT 99495 and 99496)
  • Home Healthcare Supervision (HCPCS G0181)
  • Hospice Care Supervision (HCPCS G0182)
  • Certain End-stage Renal Disease (ESRD) services (CPT 90951- 90970)
• Principal Care Management (PCM)
• Reimbursement Opportunities
• Benefits of Implementing CCM
• Population Analysis
• Case Manager Case Load
• Pros and Cons of Outsourcing CCM
• Tips for Outsourcing Success
• What to look for in the Clinical Team
• CCM Platforms Overview
• What to look for in the software
• Pros and Cons of Using EMR for CCM
• Challenges in the space
• Best Practices
• Live Q&A Session

Attendees:

• Nurses
• Doctors
• Nurse Practitioner
• Population Health Officers
• Innovation officers
• CNO/ CMO
• Billers
• Physicians
• PCP (MD, NP, PA)
• Specialists (MD, NP, PA)
• Nurse Managers
• C-Suite Healthcare Executives