Code offers chance to test care management skills

#5in5_Blog_BannerSo far doctors are underutilizing a reimbursement option designed to help bridge the gap between fee-for-service and value-based care.

More than a year ago the government created the chronic care management code (CCM). It provided a way to pay doctors for time spent coordinating care for Medicare beneficiaries – specifically those diagnosed with two or more chronic conditions and enrolled in a fee-for-service program. The reimbursement adds up to an average of $42 per patient per month.

Stanford University School of Medicine researchers found CCM reimbursement could add up to as much as $77,295 in increased annual revenue for a typical primary-care practice, according to Modern Healthcare. But a representative from the Centers for Medicare and Medicaid Services said of an estimated 35 million beneficiaries who would be eligible, reimbursements were submitted for only about 100,000 as of September 2015.

Healthcare IT News cited The National Chronic Care Management Survey, which found only a quarter of respondents created a CCM program. About half of those submitted a claim and were paid.

Both web sites listed similar obstacles to wide spread adoption of the code. They list a lack of awareness and questions about electronic health record requirements. Doctors may also hesitate to obtain the required consent to submit claims for patients not accustomed to paying for care management.

Jay Levine, vice president of provider population health management services at Optum, says learning to utilize the CCM code and others like it could be worthwhile, especially for any organization working to create or improve transitional case management programs.

“If a patient who meets the criteria and has opted in for CCM services gets admitted, the time spent managing the transition home can be included in the required 20 minutes per month of documented care coordination time,” says Levine.

“In addition, CMS also has codes to reimburse physicians for transitional case management 30 days post discharge.”

Levine answers questions on population health management in a #5in5 Podcast. Click here to listen. He explains why it’s important, even for providers still reimbursed through fee-for-service contracts.

About the Author:

LH_low-resLeslie Cozatt currently serves as Director of Marketing, Optum Provider – Thought Leadership and Content Strategy.

She directs the development of content that spotlights the role of data analytics in healthcare – specifically the transition to value-based care, risk management and population health management. She brings to her role more than 20 years of experience developing B2B and B2C integrated marketing campaigns for companies including ThreeWire, Eliance and 3M. Leslie attended the University of Minnesota and graduated from Wellington College with a BS in International Business & Communication.

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