Thanks for your inquiry Tom.
Yes, CCM service can be telephone contact by the nurse to answer your question simply. But below is a more practically useful analysis that you may want to evaluate for your practice:
Definitition of CCM services: at least 20 minutes of a practice's clinical staff time that is DIRECTED by a physician or other qualifying nonphysician practitioner (PAs, ANPs)
Is CCM new? - No, all of us already do some level of CCM. Before, Medicare and most other payers until currently argued that CCM services were bundled into the office visit. Medicare has changed its position recognizing that many patients with chronic health conditions then simply end up receiving attention only episodically to the extent they are seen during office visits or hospitalizations. These new service codes recognize the CCM services that we already do and were not previously being paid for. The "great change" I was referring to in my first reply is evolving towards a culture and professional expectation of "proactive" CCM as opposed to "reactionary" CCM when something is amiss with a patient.
As for DIRECTING CCM service: Yes, most of us already do.
Do you personally or have you ever directed your staff to return patient calls, speak to other specialists on behalf of your patient, do medication management such as reconciling med lists, communicate with your patient's caregivers, speak to home health nurse, etc, etc on behalf of your patient's care when the patient is not with you in the office. Is it even possible to take care of a patient by directing care only when they are in the exam room with you?
How do you capture the services you are already providing into a billable CCM code 99490? - below are the requirements:
1) beneficiary written consent (I shared a template in my earlier post about billing for CCM)
2) 20 minutes of documented non face-to-face care coordination efforts
3) have 5 specific capabilities
1-certified EHR (which you should already if you are an AC user)
2-maintain an electronic Care Plan that is accessible to your care team
which you should meet by care team member having access to the EMR and
providers having remote access capability when away from the office
(MyPHTS can facilitate your ability to maintain an electronic Care Plan
this within the context of the EHR AC that you already have;
you can do a care plan visit on your own within your AC note without
leveraging a technology like MyPHTS; it just won't be as easy;
MyPHTS was developed by practicing primary care physicians looking
for solutions to overcome challenges faced in our everyday patient
care experiences. The first month trial is free. Then $49.99 per
provider per month. Do your own research. There are other CCM
technology services being advertised on the web. They are out of
reach for many of us in private practice- too expensive or just don't
answer our practical needs in a easy way. MyPHTS is a patient centered
care management tool that helps both providers and patients.)
3-beneficiaries should have access to care (routine office appointments,
able to reach you or a covering provider 24/7 for guidance on
acute or urgent needs, enhanced opportunities to communicate with
you by telephone or other asynchronous methods such as web-services
like MyPHTS although beneficiaries are not compelled to use these
methods)
4-facilitate transitions of care (see the information I shared above
about TCM services for post hospitalizations, follow ups after ER
visits, coordinated referrals to other providers, be able to share
information with other providers as appropriate - your AC is able to
to do this)
5- engage in coordinating care (you do this already)
Would you do better just seeing an extra patient a month?
1) Patients that need to be seen need to be seen period that's the access part of the CCM requirement. My question for you Tom is - are you able to take care of all your patients just within the face-to-face office visits? The likely answer is no and that aspect of what you already do is the CCM service we already provide. The goal would be to evolve a culture of "proactive management" and not mostly "reactive managment".
2) You would do better seeing your patient AND capturing the service charge for the previously unbillable CCM service that most of us already provide albeit in a disorganized fashion.
The MyPHTS team will help you develop the clinical workflow protocol that makes sense for your practice situation. MyPHTS tool is flexible and adaptable to providers' unique workflows or areas of interest.
You may reach me through info@myphts.net and also visit:
www.myphts.com Regards,
MKO
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