Private and Confidential CHRONIC CARE MANAGEMENT CPT: 99490 1 Dennis Mihale, MD, MBA...

1Private and Confidential

CHRONIC CAREMANAGEMENT

CPT: 99490

Dennis Mihale, MD, [email protected]

PRIVATE & CONFIDENTIAL

A technology-enabled services platform for providers to offer aChronic 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

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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 CareSyncCareSync 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: 99490Pays approximately $46 (in CT) per month to providers who deliver 20+ minutes of non-face-to-face chronic care coordination to eligible Medicare beneficiaries.

RequirementsWhile 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.

8Private and Confidentialcaresync

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

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What is so Good About This New Code?

EVERYTHING

What’s In It For Me?

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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 • Patient Centric Care

• Access - Understanding - Use

• Fewer ER visits and Admissions

• Improved Self Management

• Administrative Services delivered at home: patient avoids travel

• Clinical visit focuses on patient care, treatment and improvement

• Ability for patient and family to participate in care

• All patient information in one secure place

• Improved outcomes and patient satisfaction helps with STARS

• 24/7 Access to Healthcare Assistants (CareSync)


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


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 conditionsThese 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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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.

Patient Consent

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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

The Comprehensive Care Plan

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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.

The Comprehensive Care Plan: Technology

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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?

Technology Requirements

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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

Additional Requirements


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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• 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)

What Revenue Is In It For Me?


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


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


Welcome Kits


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]

http://info.caresync.com/csms-ipa

http://info.caresync.com/csms-ipa


CHRONIC CAREMANAGEMENT

CPT: 99490

Dennis Mihale, MD, [email protected]


APPENDIX

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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 Private and Confidential

caresync

APPENDIX A: The Co-Pay

Private and Confidential CHRONIC CARE MANAGEMENT CPT: 99490 1 Dennis Mihale, MD, MBA...

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