How to Boost Income With Chronic Care Management


February 26, 2015

In This Article

Should You Do Chronic Care Management?

In brief, CCM services call for at least 20 minutes of clinical staff time (per calendar month) directed by a physician or other qualified healthcare professional. Beneficiaries must be Medicare patients who have been diagnosed with two or more chronic conditions that are expected to last at least 12 months (or until death) and create risk for death or decline for the patient.

Dr Rosenberg acknowledges the challenges involved in transitioning to offering this type of care, but feels that the potential rewards are worth it.

The big draw, Dr Rosenberg says, is that many services the practice provides for patients are unreimbursed, but now the practice can get paid for much of the time spent on these activities. "One of the problems is that up until now, everything billable is based on a face-to-face visit. That means I can't bill for something if the patient doesn't come in," he says.

"Our three doctors work as independent providers, and we also have an nurse practitioner. Our patient panel includes about 15,000 patients. We see all ages, from newborns to patients in hospice care. We take all insurance, including Medicare, although I'm the only one who takes Medicaid. Our practice has been a medical home for several years.

"In terms of chronic care, there's a lot of non-reimbursed healthcare work that's expected of physicians," says Dr Rosenberg. "It puts a tremendous strain on the office.

"In other professions, such as law, if you talk on the phone with a client, you can charge a fee, but that is not generally done in medical practice," Dr Rosenberg notes. "That means many practices can't afford to do certain things for patients. I know several clinicians who have shifted their practices so that they don't do things over the phone anymore. But we have never stopped; we provide a lot of care for patients even when they're not in the office. Now we will be able to offer more out-of-office help than we had done before, because of this reimbursement."

Physicians taking call during off-hours and helping patients file for insurance are two big areas of phone-based care that can now be covered under the code.

"Currently, I can't afford to take phone calls in which the patient is confused about how to file for insurance," says Dr Rosenberg. "In addition, we have always offered 24-hour coverage by a physician and have never been reimbursed for that. But now if a patient calls at 8 PM and has to discuss something, it makes it easier for us to get reimbursed."


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