Specialists Offer Chronic Care Management Services

Posted on  September 6, 2017


It would seem to many providers that Chronic Care Management (CCM) services make the most sense for Primary Care Physicians (PCP). After all, they are the clinicians that manage a multitude of ailments for their patients, specifically those with multiple chronic illnesses.  However, general practitioners are not always on board with adding Chronic Care Management to the services they offer.  It’s not because they aren’t aware of the need.  Many times, the process of hiring someone that understands the reimbursement requirements the Centers for Medicare and Medicaid Services (CMS) imposes, in addition to creating educational material, hiring general staff, and carrying out the monthly phone calls to patients simply seems too overwhelming.  Especially for smaller practices and those located in rural areas.

If the primary care provider chooses not to offer CCM services, what does that mean for the patient?  Clearly, research shows that Chronic Care Management reduces costly hospitalizations, emergency room visits and improves health outcomes. Millions of patients across the United States are benefiting from these services.  How then, do we ensure that all patients have access to this type of care when their PCP does not offer it?


Enter the Specialist

Turns out, the assumption that the PCP should be the provider of CCM services is not exactly correct.  It’s not only the primary care physician that can offer Chronic Care Management services.  In fact, any physician can offer them to his patients.  The most interesting part is that CCM can be provided under general supervision so the physician himself doesn’t have to add CCM to his personal workload.

In the past year, there has been a dramatic increase in specialists who are providing Chronic Care Management to their patients when the primary care provider does not offer them.  It works especially well whether the provider chooses to hire additional staff or outsource the services.  The added benefit is felt across the board.  No only are specialists seeing improved health outcomes, but their patients are reporting an increased quality of life and satisfaction overall.  And that’s before we consider the additional revenue the practice is adding to their bottom line.

At this point in time, the national average that CMS reimburses for CCM services is $40.83 per month, per patient receiving CCM.  Many states reimburse at much higher rates.  Most electronic health record software systems allow you to run reports identifying patients with two or more chronic diseases.  Once you identify the patients who qualify and confirm that they are not already receiving CCM services from their PCP or another specialist, you will be able to determine if CCM is a good step for your practice.  For a complete list of eligible chronic diseases, visit the CMS website located here:   Eligible Chronic Conditions.   For a complete list of billing codes, use this informational document provided by CMS:  Billing Codes.

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