As we move into 2024, healthcare systems around the world face the daunting challenge of managing the increasing prevalence of chronic diseases. More than ever, healthcare providers are turning to innovative solutions like chronic care management (CCM) to address the growing need for comprehensive care and to improve patient outcomes. This shift is essential not only for the sustainability of healthcare providers but also for the well-being of patients managing chronic conditions.
In this blog, we will explore the importance and the benefits of CCM. Nowadays, healthcare providers focus on addressing the growing needs of chronic diseases. Improving the patient outcomes, financial advantages through CPT codes and the integration of electronic health records (EHR). Also, we will examine how remote patient monitoring supports and enhances chronic care management for proactive care.
What is Chronic Care Management?
CCM refers to the care coordination services provided to patients with two or more chronic conditions that are expected to last at least 12 months or until the end of life. These services play a critical role in preventing the escalation of chronic diseases and in helping patients live healthier lives. With the proper comprehensive care plan, healthcare providers can reduce hospitalizations, emergency department visits, and the overall cost of care.
The Role of CPT Codes in Chronic Care Management
When discussing CCM, it’s crucial to understand the importance of CPT codes in billing and documentation. Specifically, code 99490 is used to bill for at least 20 minutes of care coordination services provided by clinical staff under the supervision of a healthcare professional. This code helps ensure that providers are reimbursed for the time spent managing their patients’ chronic conditions. The code can be billed monthly, as long as the chronic care management services meet the criteria outlined by Medicare.
Complex CCM services, which typically require more time and resources, also have specific billing codes, allowing providers to receive reimbursement for more intensive care coordination efforts. These include codes for additional time spent on tasks such as creating and revising comprehensive care plans, reviewing patient data, and coordinating with other care team members.
Chronic Care Management (CCM) Services in RHCs and FQHCs
Since January 1, 2016, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) have been able to bill for CCM services, which have become increasingly important for healthcare providers in 2024 as chronic disease prevalence rises.
The CY 2017 PFS final rule ensured that CCM requirements for RHCs and FQHCs were streamlined to match those of other practitioners, minimizing administrative burdens (Physician Fee Schedule, 2023).
Additionally, the flexibility introduced during the Public Health Emergency (PHE) for COVID-19 led to easier beneficiary consent processes, which CMS is now considering making permanent. These updates highlight how CCM continues to evolve, providing healthcare providers with essential tools to manage chronic conditions more efficiently, particularly in underserved areas.
Benefits of Chronic Care Management for Healthcare Providers
Improved Patient Outcomes
The introduction of CCM by CMS in 2015 expanded access to coordinated care for over 684,000 Medicare beneficiaries, particularly those with poorer health in the South. Providers managing CCM patients saw reduced hospitalizations and improved patient quality of life through proactive, personalized care. On average, providers managed 47 patients per month, with solo practitioners earning about $300 monthly by managing at least 10 patients, highlighting the financial and clinical benefits of CCM.
Enhanced Reimbursement Streams
In 2015, the CMS launched CCM services to improve care coordination for Medicare beneficiaries with chronic conditions. Within the first two years, over 684,000 beneficiaries received these services, primarily managed by primary care physicians (PCPs), who handled 68% of the claims. Providers can bill for CCM services using CPT codes like 99490 and 99491, with individual providers managing around 47 patients per month.
For smaller practices, managing just 10 patients can lead to around $300 in CCM fees monthly, and larger practices handling 150 patients can see significantly higher compensation. While some providers have concerns about patient consent and cost-sharing discussions, many beneficiaries with supplemental insurance report minimal out-of-pocket costs. Overall, CCM enhances care for chronic conditions while providing essential support to healthcare practices.
Efficient Use of Clinical Staff Time
Chronic care management allows healthcare providers to maximize the time spent by clinical staff on patient care. By outsourcing routine care coordination to nurses, medical assistants, and other clinical team members, physicians can focus on face-to-face interactions with patients who require their expertise. This efficient delegation of tasks helps streamline operations while ensuring that patients receive timely, coordinated care.
Integration with Electronic Health Records (EHR)
In 2024, the integration of chronic care management services with EHR systems is essential. CCM integration with EHR enables providers to easily document, track, and bill for CCM services, ensuring seamless communication between the care team and the patient. This helps reduce administrative burdens and provides a comprehensive view of the patient’s health over time, making it easier to adjust care plans as needed.
Who Qualifies for Chronic Care Management?
According to Medicare, individuals with two or more chronic conditions, such as arthritis or diabetes, that are expected to last at least a year, can qualify for CCM. These services include the development of a comprehensive care plan that outlines the patient’s health problems, medications, healthcare providers, and necessary community services.
Healthcare providers coordinate care, assist with medication management, provide 24/7 access for urgent needs, and offer support during transitions between healthcare settings. To receive these services, patients must sign an agreement, and there may be a monthly fee, along with applicable Medicare Part B deductibles and coinsurance. Supplemental insurance or Medicaid may help cover these costs.
How Chronic Care Management Services Work
At the core of chronic care management is a comprehensive care plan tailored to each patient’s unique needs. These plans are created in collaboration with the patient, their family, and the care team members responsible for providing ongoing care. The services include reviewing the patient’s medical history, medication management, scheduling regular check-ups, and coordinating with other specialists involved in the patient’s care.
A critical component of chronic care management is the tracking and recording of patient interactions. Clinical staff time is monitored to ensure that at least 20 minutes of care coordination is provided each month. For more complex cases, an additional 30 minutes of care can be documented and billed accordingly.
In many cases, CCM services do not require face-to-face interaction. Much of the care coordination can be performed remotely, allowing for continuous monitoring and timely intervention when needed. The use of technology, particularly EHR and other digital health tools, ensures that providers have access to up-to-date patient information at all times.
The Role of Remote Patient Monitoring in Chronic Care Management
Incorporating tools like RPM into CCM programs can significantly enhance the quality of care provided to patients with chronic conditions. By using RPM, healthcare providers can continuously monitor patients’ vital signs, detect any early signs of deterioration, and intervene before the condition worsens. This proactive approach not only improves patient outcomes but also reduces the likelihood of costly emergency room visits or hospitalizations.
To explore how DrKumo’s Remote Patient Monitoring (RPM) can complement your existing Chronic Care Management (CCM) services, visit DrKumo’s Remote Patient Monitoring page.
To learn more about how remote patient monitoring can complement chronic care management, you can visit DrKumo’s Remote Patient Monitoring page.
The Future of Chronic Care Management in 2024
As we move further into 2024, the demand for chronic care management will continue to grow. The aging population, the increasing prevalence of chronic diseases, and the need for more coordinated care solutions are driving the expansion of CCM services. Healthcare providers must adapt to these changes by integrating chronic care management services into their practices, ensuring that patients receive the care they need to manage their conditions effectively.
Moreover, disease management protocols play a vital role in the success of CCM programs. These protocols provide evidence-based guidelines for managing chronic conditions, helping providers make informed decisions about patient care. You can learn more about these protocols on DrKumo’s Disease Management Protocols page.
Takeaways
In 2024, chronic care management is no longer optional for healthcare providers—it’s a necessity. The benefits of CCM, from improved patient outcomes to enhanced revenue opportunities, make it an essential component of modern healthcare. Providers who embrace chronic care management services will be better equipped to manage the growing burden of chronic diseases, ensuring that their patients receive the best possible care.
As the healthcare landscape continues to evolve, providers must also remain aware of emerging technologies and best practices. RPM, EHR, and comprehensive care plans are just a few of the tools that can enhance CCM efforts.
Don’t let your practice fall behind in 2024. Learn how DrKumo’s innovative Chronic Care Management solutions can transform the way you deliver care.
For additional insights into best practices and technologies that support chronic disease management, check out DrKumo’s implications of remote patient monitoring practices.
Incorporating CCM into your healthcare will not only improve patient outcomes but also provides a sustainable solution for managing chronic conditions effectively. Learn more about our services or contact us today to explore how our chronic care management solutions can transform your practice.
Disclaimer:
The content of this blog is for informational purposes only and is not intended as a substitute for professional medical billing or healthcare advice. Healthcare providers should consult Medicare guidelines or professional resources when implementing Chronic Care Management services. Always refer to current regulations and billing practices for accurate implementation.
