Chronic care management (CCM) was originally brought into light back in 2015, when the Centers for Medicare and Medicaid Services (CMS) decided to reimburse for CCM services as a new division of medical expense. In order to qualify for it, the patient must have two chronic conditions, if not more.
What Exactly Defines CCM?
CCM is difficult to define without context, but there are two aspects to the definition as a whole. Generally speaking, CCM includes all monitoring and educative services provided to a patient who is suffering from any one or multiple chronic diseases, outside of acute/emergency treatment and care services.
However, the definition of chronic care management by the Centers for Medicare and Medicaid Services is not exactly similar to the generalized notion. In order for a patient to qualify for CCM expense reimbursements, the conditions as stated next must be fulfilled:
- CCM is to be treated as care coordination services, separate from the ones received by a patient on coming in for a scheduled, regular visit/treatment/examination
- The patient must have at least two, if not more than two chronic health complications
- Each of the two or more chronic conditions should be expected by a licensed physician to last for at least a year from the date of diagnosis
- The above doesn’t apply for mortal conditions in which the patient is not expected to survive for 12 months
- The services should be necessary in the sense that without them, the patient is unlikely to survive
- The CCM services must at least be necessary enough so that the patient would lose cognitive and physical functionalities without them
Professionals and the Services Provided by them in CCM
A list of professionals who can be part of a patient’s CCM plans may or may not be limited, depending on the condition of the concerned patient. This means that physicians, nurses, nurse practitioners and other required professionals associated with the care coordination plan can provide reimbursable services to a patient.
However, only one of those professionals will be reimbursed by the CMS per month. The total time period spent by a CCM professional in providing their services should not be below the twenty-minute mark if they are to bill the Centers for Medicare and Medicaid Services for a reimbursement.
Role of CCM Solutions in Care Coordination
The role of CCM solutions has turned out to be revolutionary for both patients and associated professionals in a care coordination plan. For example, the popular chronic care management solution ChartSpan makes everything more efficient and productive by bringing in the following features to CCM:
- Identifies eligible beneficiaries for the Medicare CCM program
- Reminds about and arranges for med refills, regular/urgent/emergency patient transportation, lab access, etc.
- Arranges for home care support professionals and other necessary resources
- Finds and makes appointments with the best physicians and/or other medical professionals
- Formulates customized care coordination plans for each patient under the establishment’s/professional’s care
This is just an introduction to everything that CCM solutions help with, in order to boost productivity, increase revenue, increase profits, improve and speed up patientcare, as well as meet established objectives pertaining to each patient individually. In order to understand the full scope of opportunities here, you will need to contact a reputed CCM program builder and provider.
What Should a Patient Enrolled in CCM Expect?
It should never be forgotten who the prime beneficiaries are in the Medicare program which subsidizes critical care management expenses for qualifying patients. The government package has been established to help eligible citizens, so it is important that we discuss what a patient should be expecting by becoming a beneficiary of the CCM program. Before we get to that, take heed of the two primary points mentioned below, before attempting to enroll any qualifying patients into the program:
- No establishment has the right to make anyone a beneficiary, unless they provide a clear statement in the move’s favor, via verbal and/or written consent.
- The patient must be comprehensively made aware of every requirement, benefit, cost-sharing aspects and limitations of the reimbursements on offer.
As for patients who do agree with everything after becoming fully aware, they can expect the following as part of their critical care management program:
- 24×7 CCM services for both urgent and regular care needs
- Familiarity and consistency; they should be taken care of the same individuals as always, as best as possible under the circumstances and excepting emergencies
- Customization options in the plan to fit in a patient’s specific regular physical, psychological and critical care needs
- All EHR records should be securely handled, updated and made available to the qualifying medical professionals
Common Issues in CCM Adoption
CCM, in spite of its 5-years+ presence in the country, has not yet managed to attain the same level of popularity, as the CMS had hoped it would by now. This disparity between expectations and reality is a result of:
- Confusion in patients who do not understand the program well enough
- Fear among patients of being billed beyond their capacity to pay
- Apprehension developed by a large number of applicable medical care institutions towards government aids
In order to get over these barriers, measures must be taken to appropriately address each issue individually and with due consideration. Nevertheless, the problems are quite similar in most institutions, which is why the following few strategies might work exceptionally well for getting better results:
- Adoption of automated programs that can make medical establishments aware of eligible beneficiaries as soon as they come into contact with them
- Monthly claim filing should help avoid confusions altogether
- Discussing the advantages of getting enrolled as a beneficiary in the program with eligible patients
- Establishing with them a clear idea regarding how much they would have to pay after the reimbursements.
There might be additional opportunities for reimbursements in the private segment as well. Such programs are often commercial in nature, but charitable institutions and their local subsidization programs for care management are also available at times.