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© 2018 | Payoda - Confidential
1
The ‘How’ of Chronic Care Management
www.healthviewx.com
© 2018 | Payoda - Confidential
Chronic conditions are long-term illness such as cancer, diabetes, chronic bronchitis, congestive
heart disease depression, asthma, cirrhosis of the liver, hypertension etc. which requires an
extended period of care.
The Chronic Care Management at CMS is intended to provide 20 minutes non face-to-face services
for patients suffering from two or more chronic conditions by providers, they can either use mHealth
or telehealth technology to fulfill the CCM criteria.
CMS has emphasized the importance of care in population health. From 2015, it has started to pay
Medicare providers for providing CCM service of 20 minute for 30 day calendar month. Under CPT
code 99490, eligible providers are paid $42.60(average) per Medicare patient only to those patients
who have agreed to pay 20% co payment.
Chronic Conditions
© 2018 | Payoda - Confidential
The reason behind this payment is to improve the wellness of the people. Increase in the number of
chronic diseases and poorly coordinated US healthcare system makes chronic care patients to
suffer. It is estimated that by 2030 half of the US population might have more than one chronic
conditions. After providing this extended care service, healthcare has seen a significant
improvement in care. Offering aftercare service post hospital visits shows positive results in health
outcomes.
Why Chronic Care Management?
© 2018 | Payoda - Confidential
CCM Scope of Service
© 2018 | Payoda - Confidential
Structured Way of Recording Data
The CCM service includes a recording of patient health data, an electronic care plan,
access to care management services, managing transitional care, and coordinating and
sharing patient information.
1. The structured way of recording data
A patient record should contain details of demographics, problems, medications and
medication allergies in a structured clinical summary record using certified EHR
technology.
© 2018 | Payoda - Confidential
Creating e-care plans
a. A patient-centered care plan is created based on a physical, mental, cognitive,
psychosocial, functional, and environmental needs of the patient.
b. Any modification in care plan should be recorded and updated in the patient medical
record.
c. Ensure this care plan can be accessed by any physician inside and outside the network.
© 2018 | Payoda - Confidential
Access to Care Management Services
a. 24/7 Service
Giving 24/7 service a day in per calendar month for patients to make timely contact with
health professionals during or after emergency.
b. Care Continuity
A patient can communicate with care providers, make successive routine appointments
easily and also get suggestions or advice on medications via telephone, secure
messaging, or video calling.
© 2018 | Payoda - Confidential
Manage Care Transitions and Coordination
Manage Care
Care Management Service includes a systematic way of assessing patient needs,
system-based approach to billing process, and medication reconciliation.
Managing care transitions among providers
With the use of electronic medical records, it is easy for providers to make quick
referrals and follow up process during and after an emergency with skilled nurses, and
practitioners.
Coordination
CCM services also help to coordinate with home and community based clinical
facilities by sharing patient data with providers and practitioners outside of the
network.
© 2018 | Payoda - Confidential
Each practice will have its own system of documentation for billing. 20 minutes of non-face-to-face
service should be taped in a more detailed form, including caregiver name, time logs, physician
feedback, record changes in a care plan, and integrated with EHR.
In order to avoid duplicate payment, CMS pays Medicare providers separately for care management
and CCM service as it believes that care management is an integral part of all of these services.
The CCM CPT code (99490) cannot be billed when the patient also get service under
Transitional care management codes (99495-99496)
Home or community clinical service codes (G0181-G0182)
End-stage renal disease services codes (90951-90970)
Documentation / Billing
© 2018 | Payoda - Confidential
Physician Reimbursement
CMS pointed that providers have to meet other criteria in order to qualify for CCM
payments. The criteria are listed below:
1. Using certified EHR
CCM service requires the use of certified EHRs to record the services offered for future
reference and documentation purposes.
EHR helps members of hospitals to access patient record at the same time. It helps
them to get updated information about patient’s health issues and can give effective
treatment.
© 2018 | Payoda - Confidential
Physician Reimbursement
2. Time spent on CCM service
If many physicians are involved in same patient’s care then each physician are paid for the
time spent on care. Time logs will act as a time tracker to avoid duplicate billing.
3. Getting patient approval
To be reimbursed by CMS, patients must agree to pay $8 monthly copay. Since it is a new
process and some patients may not understand why they have to pay for something they
were previously getting for free.
© 2018 | Payoda - Confidential
Features of HealthViewX CCM Software
© 2018 | Payoda - Confidential
1 Automated call log feature
After a call, care plan creation or any action related to CCM health services,
the system automatically adds call logs. It reduces the physician’s manual
effort is logging the call logs.
© 2018 | Payoda - Confidential
Preventive Care Plans
2
HealthViewX solution supports care plans for the Chronic Care Management
service for a patient. The physician can create a care plan depending on the
patient’s health report. It helps in monitoring the patient’s vitals.
© 2018 | Payoda - Confidential
Chronic Care Management
Analytics3
Dashboards with intuitive charts and tables give complete analytics of the
Chronic Care Management services. It provides a clear picture of the revenue
perspective
© 2018 | Payoda - Confidential
4 Consolidated Reports
The physician can generate a consolidated report of the Chronic Care
Management services given for a particular period. This makes it easy for
the billing practitioner for getting the Medicare reimbursements.
© 2018 | Payoda - Confidential
HIPAA Compliance
5
HealthViewX Chronic Care Management is HIPAA compliant. It facilitates
secure data exchange. The solution manages all patient-related documents
securely.
© 2018 | Payoda - Confidential
HealthViewX Care Management and Chronic Care
Management solutions have features that suit
healthcare organizations best.
To know more about our solutions, schedule a
demo at www.healthviewx.com
Schedule a Demo with HealthViewX
Email: marketing@healthviewx.com
Phone: +1 (214)-461-0242Contact us anytime.
How can we help?

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The how of chronic care management

  • 1. © 2018 | Payoda - Confidential 1 The ‘How’ of Chronic Care Management www.healthviewx.com
  • 2. © 2018 | Payoda - Confidential Chronic conditions are long-term illness such as cancer, diabetes, chronic bronchitis, congestive heart disease depression, asthma, cirrhosis of the liver, hypertension etc. which requires an extended period of care. The Chronic Care Management at CMS is intended to provide 20 minutes non face-to-face services for patients suffering from two or more chronic conditions by providers, they can either use mHealth or telehealth technology to fulfill the CCM criteria. CMS has emphasized the importance of care in population health. From 2015, it has started to pay Medicare providers for providing CCM service of 20 minute for 30 day calendar month. Under CPT code 99490, eligible providers are paid $42.60(average) per Medicare patient only to those patients who have agreed to pay 20% co payment. Chronic Conditions
  • 3. © 2018 | Payoda - Confidential The reason behind this payment is to improve the wellness of the people. Increase in the number of chronic diseases and poorly coordinated US healthcare system makes chronic care patients to suffer. It is estimated that by 2030 half of the US population might have more than one chronic conditions. After providing this extended care service, healthcare has seen a significant improvement in care. Offering aftercare service post hospital visits shows positive results in health outcomes. Why Chronic Care Management?
  • 4. © 2018 | Payoda - Confidential CCM Scope of Service
  • 5. © 2018 | Payoda - Confidential Structured Way of Recording Data The CCM service includes a recording of patient health data, an electronic care plan, access to care management services, managing transitional care, and coordinating and sharing patient information. 1. The structured way of recording data A patient record should contain details of demographics, problems, medications and medication allergies in a structured clinical summary record using certified EHR technology.
  • 6. © 2018 | Payoda - Confidential Creating e-care plans a. A patient-centered care plan is created based on a physical, mental, cognitive, psychosocial, functional, and environmental needs of the patient. b. Any modification in care plan should be recorded and updated in the patient medical record. c. Ensure this care plan can be accessed by any physician inside and outside the network.
  • 7. © 2018 | Payoda - Confidential Access to Care Management Services a. 24/7 Service Giving 24/7 service a day in per calendar month for patients to make timely contact with health professionals during or after emergency. b. Care Continuity A patient can communicate with care providers, make successive routine appointments easily and also get suggestions or advice on medications via telephone, secure messaging, or video calling.
  • 8. © 2018 | Payoda - Confidential Manage Care Transitions and Coordination Manage Care Care Management Service includes a systematic way of assessing patient needs, system-based approach to billing process, and medication reconciliation. Managing care transitions among providers With the use of electronic medical records, it is easy for providers to make quick referrals and follow up process during and after an emergency with skilled nurses, and practitioners. Coordination CCM services also help to coordinate with home and community based clinical facilities by sharing patient data with providers and practitioners outside of the network.
  • 9. © 2018 | Payoda - Confidential Each practice will have its own system of documentation for billing. 20 minutes of non-face-to-face service should be taped in a more detailed form, including caregiver name, time logs, physician feedback, record changes in a care plan, and integrated with EHR. In order to avoid duplicate payment, CMS pays Medicare providers separately for care management and CCM service as it believes that care management is an integral part of all of these services. The CCM CPT code (99490) cannot be billed when the patient also get service under Transitional care management codes (99495-99496) Home or community clinical service codes (G0181-G0182) End-stage renal disease services codes (90951-90970) Documentation / Billing
  • 10. © 2018 | Payoda - Confidential Physician Reimbursement CMS pointed that providers have to meet other criteria in order to qualify for CCM payments. The criteria are listed below: 1. Using certified EHR CCM service requires the use of certified EHRs to record the services offered for future reference and documentation purposes. EHR helps members of hospitals to access patient record at the same time. It helps them to get updated information about patient’s health issues and can give effective treatment.
  • 11. © 2018 | Payoda - Confidential Physician Reimbursement 2. Time spent on CCM service If many physicians are involved in same patient’s care then each physician are paid for the time spent on care. Time logs will act as a time tracker to avoid duplicate billing. 3. Getting patient approval To be reimbursed by CMS, patients must agree to pay $8 monthly copay. Since it is a new process and some patients may not understand why they have to pay for something they were previously getting for free.
  • 12. © 2018 | Payoda - Confidential Features of HealthViewX CCM Software
  • 13. © 2018 | Payoda - Confidential 1 Automated call log feature After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
  • 14. © 2018 | Payoda - Confidential Preventive Care Plans 2 HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
  • 15. © 2018 | Payoda - Confidential Chronic Care Management Analytics3 Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective
  • 16. © 2018 | Payoda - Confidential 4 Consolidated Reports The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
  • 17. © 2018 | Payoda - Confidential HIPAA Compliance 5 HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.
  • 18. © 2018 | Payoda - Confidential HealthViewX Care Management and Chronic Care Management solutions have features that suit healthcare organizations best. To know more about our solutions, schedule a demo at www.healthviewx.com Schedule a Demo with HealthViewX
  • 19. Email: marketing@healthviewx.com Phone: +1 (214)-461-0242Contact us anytime. How can we help?