We have all been subject to routine medical appointments and for the lucky few, this is all that’s needed. However, for more than 130 million Americans suffering from chronic conditions, this is not enough.
Living with a chronic condition requires more than a routine check-up once a year and without proper services, becomes costly for patients, providers, and the government. An average of 85% of Federal healthcare dollars are allocated to the treatment of chronic conditions.
This is why the Centers for Medicare and Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as:
“One of the critical components of primary care that contributes to better health and care for individuals, and holds promise for reducing overall health care costs.” 1
The Need for Chronic Care Management Services
With more than 69% of Medicare patients living with two or more chronic conditions, the need for chronic care services is evident.
In light of this, in January 2015, CMS began reimbursing practices an average of $42 per patient per month for 20 minutes of non face-to-face care. This is eligible for patients with two or more chronic conditions through the CPT code 99490. Their Healthcare Professional Toolkit provides detailed information on Chronic Care Management and its various codes. It also includes:
- How patients benefit from CCM services
- How CCM supports practices
- Additional resources
- How to get started with CCM
- How to bill for CCM services
Additionally, a study published in November 2017 by a third-party analyst has tracked the financial impact of CCM on Medicare expenditure. A brief chart below summarizes the findings but the complete study can be found here. The initial findings are compelling – to say the least.
Why Practices Outsource Chronic Care Management
At a glance, providing Chronic Care services in-house requires a lot of time and is resource intensive, which explains why many practices are outsourcing CCM services to companies such as Wellbox. Their solutions allow practices to bill for CPT code 99490, increase their revenue and provide their patients personalized care and services.
This CCM initiative helps chronic patients take charge of their health, allows physicians to bill for the chronic care they have always provided and ultimately reduces healthcare costs. With all parties benefitting from such services, we can clearly see why CMS is pushing for CCM.
The whitepaper The Case for Outsourcing Chronic Care Management” gains insight into the requirements and resource attributions of establishing such a program in-house and the benefits of outsourcing such services for practices, physicians and patients.