caresy caresync Chronic Care Management

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1 caresy Chronic Care Management

2 THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in the United States. About half of the adults in America, 117 million people, have at least one chronic condition. IN THE UNITED STATES 7of the TOP 10 CAUSES OF DEATH IN 2010 WERE CHRONIC ILLNESSES 1 GOES TO THE TREATMENT OF CHRONIC ILLNESS 2/3 of Medicare dollars ARE SPENT ON PATIENTS WITH 5+ CHRONIC CONDITIONS. Research consistently shows that effective chronic care management reduces the costs of care for chronic disease patients while improving their overall health. However, providers have not been reimbursed for non face-to-face care coordination services. Chronic disease patients are often left to coordinate between-visit care for themselves, creating huge gaps in communication, and resulting in fragmented health data, duplicated tests, increased healthcare expenses, and a higher likelihood of poor health outcomes. THE OPPORTUNITY The Centers for Medicare & Medicaid Services (CMS) recognizes the importance of Chronic Care Management (CCM) and the impact that it has on healthcare expenses and outcomes, and has started paying monthly reimbursements for care coordination services. New for 2015, Current Procedural Terminology (CPT ) 2 code pays approximately $43 per month 3 to providers who deliver 20+ minutes of non face-to-face chronic care coordination to eligible Medicare beneficiaries with 2 or more chronic conditions. These services can be fulfilled by the provider or performed by a subcontractor CPT is registered trademark of the American Medical Association 3 $42.60 per month is the national average. Actual amounts will vary by region

3 In order to bill Medicare, providers must meet several new technology and services requirements for creating and sharing comprehensive care plans with the patient and all of the patients providers. CPT The Final Rule of the 2015 Medicare Physician Fee Schedule included the new CPT 99490, defined as: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements; multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored. (CMS Final Rule, October 31, 2014) REQUIREMENTS CMS has listed specific requirements in order for providers to bill CPT They include: 24/7 access to clinical staff to address urgent chronic care needs Continuity of care through access to an established care team for successive routine appointments Ongoing care management for all chronic conditions, including medication reconciliation and the regular assessment of a patient s medical, functional, and psychosocial needs A comprehensive, patient-centered health summary and care plan that includes all current records from all the patient s providers Management of care transitions between and among all providers and settings using electronic transmission of information Coordination with home- and community-based clinical service providers Patient and caregiver access, with enhanced opportunities for all relevant caregivers to communicate about the patient s care

4 Eligible Providers CMS intent was to have primary care coordinate, but the code allows for any provider to perform the services. While the billing provider must oversee the CCM services, they are not required to be present for the work to be done. Physicians, regardless of specialty, advanced practice registered nurses, physician s assistants, clinical nurse specialists, and certified nurse midwives are all eligible to bill Medicare for CCM. Physicians, regardless of specialty, advanced practice registered nurses, physician s assistants, clinical nurse specialists, and certified nurse midwives are all eligible to bill Medicare for CCM. Non-physician and limitedlicense practitioners, such as clinical psychologists and social workers, are not eligible to bill for CCM. To date, Medicare has not recognized CCM as a rural health clinic (RHC) or federally qualified health center (FQHC) service. We expect this to change for Only one provider may bill per calendar month. Eligible Patients & Chronic Conditions: CMS has left the ruling open to discernment by the provider. The guideline simply requires: Two or more chronic conditions expected to last at least 12 months, or until the death of the patient Chronic conditions that place the patient at significant risk of death, or acute exacerbation/ decompensation CMS maintains a Chronic Condition Warehouse (CCW) 4 with 22 chronic conditions listed to provide researchers with beneficiary, claims, and assessment data, however, it is not an exclusive list. 4

5 PREVALENT HEALTH CONDITIONS AMONG HIGH-RISK PATIENTS 2.5% 5.0% 37.5% Diabetes 5.0% Hypertension Mental Health 10.0% Congestive Heart Failure Chronic Obstructive Pulmonary Disease Other Cardiac Arrhythmia Vascular 15.0% End Stage Renal Disease 20.0% Acute Myocardial Infarction/Infraction SO YOU WANT TO PROVIDE CCM FOR YOUR PATIENTS? Consent In order to bill for CCM, providers must get the patient s written consent, confirming that the following has been explained to the beneficiary: An overview of CCM How the CCM service may be accessed That only one provider can provide CCM services at a time The patient can terminate the CCM service at any point in time by revoking consent The patient will be responsible for any associated copayment or deductibles That information will be shared among all the patient s providers Once the consent form is signed, a copy must be stored in the patient s medical record. If a patient chooses to revoke consent, providers may not bill for CCM after the month the revocation was made. If the 20+ minutes of CCM has already been completed, providers may bill for that month. 5 Source: November 2014 Healthcare Performance Benchmarks: Stratifying High-Risk Patients

6 Because of this, CMS includes that providers must have flexibility to use a wide range of tools and services beyond EHR technology now available in the market to support electronic care planning. Certified EHR Any provider billing for CCM is required to use technology, which for 2015, includes an EHR that satisfies the 2011 or 2014 criteria of the EHR Incentive Program. The Care Plan At the core of the code, providers must maintain a regularly updated, electronic Care Plan that is based on an assessment of the patient s needs. The plan should include all of the patient s healthcare providers, family & caregivers, all health conditions (not just those considered chronic), and be aligned with the patient s choices and values. CMS has included the following items as recommendations to be included in the patient s comprehensive Care Plan: Comprehensive problem list including expected outcome and prognosis and measurable treatment goals Symptom management and planned interventions Accessible community and social services Plan for care coordination among all providers Medication management, including current medication list and allergies, reconciliation, and oversight of patient self-management

7 Designated person responsible for each intervention Any requirements for regular review/revision CMS requires that the care plan must be created using some form of electronic technology, but recognizes that current EHR technology is limited in its scope to support electronic Care Plans. Because of this, CMS includes that providers must have flexibility to use a wide range of tools and services beyond EHR technology now available in the market to support electronic care planning. There are three requirements regarding electronic access to the patient s care plan: All care team members must have 24/7 electronic access to the care plan The billing provider must electronically share care plan information as appropriate with other providers who are providing care for the patient The billing provider must provide a paper or electronic copy of the care plan to the patient. Additional Requirements In order to bill for CCM, providers must offer 24/7 access to a member of the care team to address urgent chronic care needs and facilitate care coordination, including successive routine appointments and enhanced opportunities for patient/caregiver-provider communication, such as Direct messaging or in-app communication. Billing providers must facilitate all transitions of care, including follow-up with a patient after a visit to the ER and post-discharge transitional care management (TCM) services 6. Additionally, providers furnishing CCM are required to coordinate referrals to other providers, as well as to share up-to-date information electronically with all the providers on a patient s care team. Lastly, providers must have the ability to coordinate care with home- and community-based providers, including home health, hospice, nutrition services, outpatient therapies, and transportation services, to name a few. Any communication with these service providers must be documented in the CCM-certified technology. CHRONIC CARE MANAGEMENT WITH CARESYNC The new Chronic Care Management code creates new opportunities for added revenue and enhanced patient care. However, caution must be taken to be certain that billing providers are compliant with the billing requirements for Many providers throughout the United States are looking for ways to offer this proven, effective benefit for their patients, while adding in a new stream of revenue. The strict billing requirements of CMS Chronic Care Management initiative are at the very core of what CareSync has been doing for years. The unique combination of industry-leading technology and care coordination services creates a turnkey, care management solution to provide CCM for your practice. 6 Providers may not bill for TCM and CCM at the same time.

8 Providers who choose CareSync s Chronic Care Management are effortlessly equipped to offer patients and their families the most comprehensive care coordination solution available. CareSync s industry-leading technology and care coordination services turn an overwhelming process into an opportunity to greatly improve your patients experiences and medical outcomes, with a positive impact on your bottom line. How does it work? Health Assistants collect medical records from all a patient s providers to build a comprehensive Care Plan and health summary that includes the CMS-required elements. Health Assistants spend a minimum of 20 minutes per patient, per month assisting with care coordination tasks including scheduling medical visits, reconciling medication lists, updating care plans, tracking adherence and more. Health Assistants are available 24/7 by phone, online, and through in-app messaging to help patients with acute chronic care issues and care coordination tasks. CareSync s Health Assistants facilitate care transitions, document the information, and keep all members of the care team up-to-date. Every medical visit is recorded, and every provider has access to the documentation via the free CareSync application and care team updates. True care coordination. CareSync offers the revolutionary ability for families to access & interact with information, share it before visits, listen to a recording of the doctor s instructions, and respond to notifications when a reminder is missed. CareSync is a true family health record.

9 In addition to meeting all of Medicare s requirements for CCM, CareSync goes above and beyond. Here are a few of the additional benefits you and your patients receive with CareSync: Our trademarked Health Timeline is an important part of your patient s history, as well as the care team s understanding of what has been done lately. The most recent 30 days of Timeline activity is included with the monthly update sent to all current providers. Free Caregiver Accounts - The patient s family members and other caregivers not only have access to the patient s information, they are encouraged to create their own free accounts to be truly engaged with the application. Medication & measurement instructions & reminders are part of every Care Plan, but CareSync turns it into an engaging opportunity to generate useful data and complete the communication loop with the providers. Visit planning tools make it easy for patients and caregivers to plan the visit by adding notes and tasks that are transmitted to the provider before the visit. A voice recorder built into the app allows the doctor s explanations and instructions to be saved. Integrations with tracking and wearable devices make it nearly effortless for patients to collect critical between-visit data. CareSync s industry-leading technology and care coordination services turn an overwhelming process into an opportunity to greatly improve your patients experiences and medical outcomes, with a positive impact on your bottom line. CareSync will provide the turnkey service and a summary at the end of each month. You bill Medicare each month, and pay only for the CareSync service. The CareSync platform is also available as a software-only option. Getting started is simple: We know you re busy. CareSync ensures that you benefit from this revenue-generating opportunity without adding to your expenses or making any changes to your current workflow. CareSync is designed to work with your current technology, and your dedicated Implementation Manager will guide you through the simple setup in just a few minutes. Visit us online at or talk to one of our Chronic Care Management experts by calling LEARN MORE

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