Transcript CareSync and Chronic Care Management

CHRONIC CARE
MANAGEMENT
CPT: 99490
Dennis Mihale, MD, MBA
[email protected]
Private and Confidential
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A technology-enabled services platform for providers to offer a
Chronic Care Management program to eligible Medicare patients.
PRIVATE & CONFIDENTIAL
Healthcare Today
This causes: increased health expenses, unengaged patients,
fragmented health data, and poor health outcomes.
Private & Confidential
CMS Creates A Massive Market
Private & Confidential
Chronic Care Management (CCM)
Agenda:
• Overview of CareSync
• Chronic Care Management (CCM) Code
• CCM Services and Technology Rules
• How CareSync Works
• How to Get Started
• Questions
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Overview of CareSync
CareSync is the leading patient-centered engagement solution that
combines technology with 24/7 nursing services to facilitate care
coordination among patients, family & caregivers, and all providers.
CareSync provides turnkey Chronic Care Management services and
a software-only option, allowing practices of any size to easily meet
the billing requirements for CPT code 99490. We began offering
our CCM services 2 years before CMS announced the new code.
CareSync’s certified technology makes it simple for providers to
meet Meaningful Use 2 for Data Exchange, Messaging, and Timely
Access.
CareSync patients are at the center of their healthcare, with access
to health information, actionable goals, and Comprehensive Care
Plan tasks, and as a result, are experiencing more productive
medical appointments and better health outcomes.
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Chronic Care Management
New for 2015!
For the first time ever, CMS has started paying monthly reimbursements
to providers who perform non face to face chronic care coordination
services.
CPT Code: 99490
Pays approximately $46 (in CT) per month to providers who deliver 20+
minutes of non-face-to-face chronic care coordination to eligible Medicare
beneficiaries.
Requirements
While a great new opportunity, CPT Code 99490 comes with a set of strict
technology and services requirements. The good news? You can
outsource them, and reap the benefits of this great new program.
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Dr. Dennis Mihale Introduction
• Directly works with
• CMS CCM team
• FSCO/DSO (MAC) CCM team
• Cover 12 southern states
• Medicare Admin Contractor
• Noridian (MAC in Northwest)
• 10 million lives
• CMS Physician Champion for ICD-10 in Florida
• Dennis and CareSync are front and center for
CMS and for thousands of practices
• Founded multiple technology healthcare companies
caresync
Private and Confidential
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What’s In It For Me?
What is so Good About This New Code?
EVERYTHING
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What’s In It For Me?
• Revenue, Respect and Recognition
• Get paid for the services you provide
• Be recognized and valued for your work
• Do it before someone poaches your patient
• A Complete Picture of My Patient (Finally!):
• Other doctors, visits, labs, tests, medications
• Things that happened between visits
• Enlist the aid of family, friends and caregivers
• Your Patient Values Your Work
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What’s In It For My Practice?
• Help other physicians taking care of my patient
• Access to critical information including medications
• Avoid duplicate tests
• Medication reconciliation and treatment adherence
• Much easier if you know what other docs are prescribing
• Medications only help if your patient takes them
• Meaningful Use Compliance
• Core Measurements 7 and 17
• These are the two tough ones
• HEDIS Compliance
• COPD, Colonoscopy and DM Management
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What’s In It For My Patients?
Benefits to Patient & Family
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Patient Centric Care
• Access - Understanding - Use
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Fewer ER visits and Admissions
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Improved Self Management
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Administrative Services delivered at home: patient avoids travel
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Clinical visit focuses on patient care, treatment and improvement
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Ability for patient and family to participate in care
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All patient information in one secure place
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Improved outcomes and patient satisfaction  helps with STARS
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24/7 Access to Healthcare Assistants (CareSync)
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Chronic Care Management Billing Protocols
• 24/7 patient access to clinical staff to address urgent
chronic care needs
• Continuity of care through access to established care
team for success routine appointments
• Ongoing care management for all chronic conditions,
including medication reconciliation and a regular
patient assessment
• A comprehensive, patient-centered health
summary and care plan that includes all patient
records from all providers
Private and Confidential
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Chronic Care Management Billing Protocols
• Management of care transitions between and among
all providers and settings using the electronic
transmission of information
• Coordination with home and community based
clinical service providers
• Patient and caregiver access, with opportunities for
all relevant caregivers to communicate about the
patient’s care
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Eligible Patients & Chronic Conditions
Medicare beneficiaries with two or more chronic conditions
These are conditions that are expected to last at least 12 months, or until
the death of the patient.
They must put the patient at significant clinical risk: acute exacerbation,
worsening of symptoms and/or death
What conditions count?
CMS maintains a Chronic Condition Warehouse with 22 chronic
conditions listed, however, it is not an exclusive list. Website:
https://www.ccwdata.org/web/guest/condition-categories
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Eligible Providers
• Physicians (regardless of specialty)
• Advanced Practice Registered Nurses
• Physician Assistants
• Clinical Nurse Specialists
• Certified Nurse Midwives
Non-physician practitioners and limited-license practitioners
such as social workers and clinical psychologists, are not
eligible to bill for CCM
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When You Cannot Bill CCM
• When your patient is in the hospital (inpatient)
• When the patient is in a Skilled Nursing Facility
• When the patient is in a Nursing Home
• When the patient is under Hospice care supervision
• When Transitional Care Management services are
billed
The rationale for these exclusions is that the services
provided significantly overlap with care management
activities that are included in the facility payments.
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Patient Consent
You must obtain the patient’s written consent, confirming that the
following has been explained to the beneficiary:
• An overview of Chronic Care Management
• How the CCM service may be accessed
• That only one provider can perform CCM services at a time
• That information will be shared among all of the patient’s providers
• That the patient may terminate the CCM service at any point in time by
revoking consent
• That the patient will be responsible for any associated copayment or
deductibles. For those without a supplemental plan, it’s roughly $9.
Once consent has been obtained, a copy must be stored in the patient’s
medical record. If a patient revokes consent, you may not bill for CCM
after the month the revocation was made. If 20+ minutes has already
been completed, you may bill for that month.
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The Comprehensive Care Plan
The patient-centric Care Plan: The spirit of 99490
• Should include all of the patient’s healthcare providers, family &
caregivers, all health conditions, and must be aligned with the
patient’s choices and values.
CMS recommends:
• Comprehensive problem list
• Symptom management and planned interventions
• Accessible community and social services
• Plan for care coordination among all providers
• Medication management and adherence tracking
• Designated person responsible for each intervention
• Requirements for regular review/revision
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The Comprehensive Care Plan: Technology
Care Plan Technology
• The Care Plan must be created using some form of electronic
technology, but CMS recognizes that current EHR technology is
limited in its scope to support electronic care plans.
Three Requirements:
• All “care team members” must have 24/7 electronic access
• The billing provider “must electronically share care plan
information as appropriate with other providers” who are
delivering care to the patient (no fax allowed).
• The billing provider must provide a paper or electronic copy of
the care plan to the patient.
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Technology Requirements
You must use Certified EHR technology
• For 2015, this includes any EHR that has met the 2011 or 2014
criteria of the EHR Incentive Program.
• You must generate a patient-centric Care Plan with records from
all providers and all disease states
• You must make the Care Plan available to the patient and all
other providers.
They do not make it easy, do they?
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Additional Requirements
24/7 access to the care team
• To address urgent chronic care needs
• Facilitate care coordination
• An answering service does not meet this requirement
Transitional Care Management
• You must facilitate all transitions of care
• You may not bill for CCM during the same month as TCM
Care Coordination
• You must have the ability to coordinate care with home and
community based providers, including home health, nutrition
services, outpatient therapies, and transportation services, to
name a few. Communication must be documented
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CareSync and Chronic Care Management
CareSync’s CCM solution has the perfect fit for practices of
all sizes.
Complete Chronic Care Management
• CareSync technology + turnkey CCM services
• We provide the service every month, you bill
Software as a Service (SaaS)
• Use of the CareSync web, iOS, and Android technology
• You meet CMS’ requirements for services provided and
use CareSync to bridge any gaps in your existing
technology
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Examples of CCM Activities
• Getting all patient records from all providers
• Creating the patient centric comprehensive care plan
• Scheduling appointments with any provider
• Helping patient fill out insurance forms
• Speaking to patient about their medications and overseeing
patient self-management of medications
• Taking calls on evenings and weekends
• Reconciling medications
• Ensuring receipt of all preventive services
• Monitoring patient conditions—Physical, mental and social
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What Revenue Is In It For Me?
• Revenue varies by Medicare Region
• It is approximately $46 per member per month
• For 100 members enrolled in CCM  $24,000 per year*
• For 1,000 members enrolled in CCM  $240,000 per year*
• There are costs associated with deploying this solution
• Staff to provide the service, unless you have people sitting
around doing nothing. Yeah – like that ever happens.
• Costs to meet technology requirements
(* Approximate revenue net of CareSync’s full service fees)
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CCM: Benefitting Providers and their Patients
Providers
• Comprehensive picture of a patient’s health
• Complete medication reconciliation and adherence
• Healthier, happier patients
• Generating new, recurring revenue
Patients
• All health information in one secure place
• Personalized Care Plan with actionable goals and tasks
• Improved health outcomes and satisfaction
• Family & caregiver access like never before
• 24/7 access to Health Assistants
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Getting Started is Easy
We’re ready to get you started today!
• No burden to you or your staff
• No disruption to existing workflows
• No cost to you
Implementation takes a few hours, not days, weeks or months!
• CareSync is designed to work with your existing technology
• Trained Care Coordinators are equipped with proven tools to
onboard your eligible patients
Private and Confidential
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Welcome Kits
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Resources and contact information
For more information, view our resource page
• http://info.caresync.com/csms-ipa
Contact: Rosemary P. Hokanson
Physician Network Education Manager
• Phone: 860-573-2580
• [email protected]
caresync
Private and Confidential
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CHRONIC CARE
MANAGEMENT
CPT: 99490
Dennis Mihale, MD, MBA
[email protected]
Private and Confidential
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APPENDIX
caresync
Private and Confidential
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APPENDIX A: The Co-Pay
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Only if no supplemental and no Medicaid
CMS values this at $46 per month
They are asking you to only pay $9.20 a month
What are you getting for this $9.20?
• 24/7 access, even when it is not urgent
• Your Family Physician knows what is happening with all
other providers just by you signing up
• No matter where you are in USA, doctors can access all
your medical information with your permission
• Help you take your medications on time
• Help you with insurance forms and surveys
• Answer questions about your insurance
• Remind you about doctor visits, labs and tests
How can they do it for Only $9.20? It’s CareSync Magic
caresync
Private and Confidential
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