Boost revenue and patient health outcomes with care management programs that complement your EHR
With COVID-19, there has never been a more important time to keep your patients well-managed in between their traditional office visits. Many healthcare providers offer care management services to their patients that were not reimbursable from Medicare before 2015. Over the last five years, The Centers for Medicare and Medicaid Services (CMS) has created a variety of programs every provider should be offering to their patients.
The programs provide a bridge to satisfying the requirements of the Quality Payment Programs by promoting interoperability, demonstrating process improvements, and driving clinical goal achievement. They offer a great way to keep patients engaged in their health while providing significant revenue opportunities to the clinic.
1. Chronic Care Management (CCM)
CMS will reimburse you $42 by providing a minimum of 20 minutes of CCM per patient per month. For practices with 100 CCM patients, that means you could earn an additional $4,200 per month.
2. Remote Patient Monitoring (RPM)
RPM can offer an additional $119 per patient per month to your practice; This includes $54 for 20 minutes of RPM staff time and $65 for providing the patient with a device to be used for daily monitoring.
3. General Behavioral Health (BHI)
BHI will reimburse doctors, on average, $48 per patient per month for 20 minutes of non-face-to-face care management services. BHI services can be used to manage patients with anxiety, depression, substance abuse issues and alcohol abuse issues.
4. Annual Wellness Visits (AWVs)
CMS allows practices to bill for a Welcome to Medicare/Initial Preventive Physical Examination (IPPE), with an average national reimbursement of $168. Afterwards, practices can bill for an Initial Annual Wellness Visit (IAWV) with an average national reimbursement of $178. And finally, CMS allows practices to bill for Subsequent AWVs with an average national reimbursement of $117. Best of all, these wellness visits have no out-of-pocket cost to the patient.
What’s stopping providers from using these programs?
Even with the high reimbursements and value to the patients, these programs are still underutilized across the country. Many practices cite the following as reasons not to use the programs:
Too time intensive
It’s always a challenge to find time in the day to do more. Many practices have found ways to flex or adapt their schedules to include telehealth visits due to COVID-19 and in the same way, we can allocate time in a schedule for these programs. Luckily, almost all of these programs can be performed by clinical staff under the general supervision of the provider. Most groups use a Certified Medical Assistant (CMA).
My patients won’t want to participate
Now more than ever, patients want to stay connected with their providers. At a time when many patients aren’t leaving their house, these programs are the perfect way to keep their conditions well-managed. As patients get used to connecting with their providers virtually, it is easier than ever to implement complimentary remote monitoring and check ins.
Programs are too confusing/too many rules
Managing the programs in spreadsheets or templates can be cumbersome and tedious, and practices don’t want to risk getting audited if steps are missed.
Allscripts partner, ThoroughCare, has developed clinician-friendly tools to simplify these programs for you and your staff. ThoroughCare is a web-based platform that integrates with Allscripts Professional EHR™ and Allscripts TouchWorks® EHR, and includes these intuitive features:
- Guided care plans and health risk assessments
- Time logging, tracking, and reporting to ensure program requirements are met
- Patient and provider reports with detailed documentation
- Detailed dashboards and reports that let you know exactly what to bill for each month
Interested in learning more? Watch a replay of the ThoroughCare June app of the month webinar.