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Is Chronic Care Management Only for Medicare Patients?

If you’ve ever considered implementing a chronic care management (CCM) program at your healthcare facility, you probably have a few questions, the biggest one being whether only Medicare patients qualify for the program. The answer is no, but Medicare chronic care management programs may have specific parameters that set them apart from others.

Other questions you might ask before you start offering these services are:

  • What does chronic care management include, particularly through Medicare?
  • What does chronic care management billing look like?
  • Where do you start when creating a chronic care management program of your own?

We answer these questions in this blog to help you create a plan for providing patients who are suffering from chronic conditions with the care they need.

What Is Medicare Chronic Care Management?

Chronic care management through the CMS (Centers for Medicare and Medicaid Services) provides care to patients with at least two chronic conditions that are expected to last for at least 12 months. Patients with these conditions have a higher chance of acute exacerbation, decompensation, decline in health, and even death. Because these patients have serious health concerns, they need continuous care to ensure they have what they need to treat their conditions. CCM programs were created in response to these challenges.

The CMS requires healthcare providers to connect with patients who participate in the CCM program for at least 20 minutes a month. These meetings do not necessarily have to take place in person. They must, however, occur outside of normal office visits. Examples of care you will provide through the CMS CCM program are:

  • 24/7 patient access to their care team
  • Creation of a chronic care management care plan
  • Regular follow-ups to check in on the patients’ health status
  • Education on what steps patients can take to maintain a healthy lifestyle with their conditions
  • Medication management to ensure patients are taking the right dosage to treat their conditions
  • Remote monitoring so that the care team can track patients’ vital signs when they’re not in the office

What Does Medicare Pay for CCM?

The amount that Medicare reimburses your healthcare facility for your CCM program will vary depending on several factors, such as:

  • Type of service
  • Legislative updates
  • Your facility’s location

As for how much Medicare will pay for a patient’s CCM bill, they will pay 80% if patients have Medicare Part B. Medicare may cover the entire cost of service for patients with both Medicare and Medicaid. How much they pay for patients with a Medicare Advantage plan will vary.

How Do I Start a Chronic Care Management Program?

To start a chronic care management program at your facility, follow these basic steps:

  1. Evaluate your facility’s resources and number of staff. Make sure you have everything for the program to run smoothly. Should you need more staff but don’t have the funds to hire new employees, you can always use care coordinators from companies like TimeDoc Health.
  2. Find patients who are eligible for the program. They must have at least two long-lasting chronic conditions. They do not have to be on a Medicare plan, but it can certainly help.
  3. Consider implementing value-based care (VBC). It focuses on providing patients with high-quality, cost-effective care. If providers give this kind of care to patients, they may be eligible to receive financial rewards.
  4. Develop an individualized care plan for each patient. Each patient will have different needs based on their conditions and lifestyle goals. Create a plan that will help patients satisfy those needs.
  5. Create a team for care coordination. You should have at least one care coordinator per team with knowledge and experience caring for patients with chronic conditions. The care coordinator will work to get each patient proper treatment.
  6. Train any staff members who will be involved in the program. Make sure your team knows what is and is not permitted through CCM guidelines as well as the details of each patient’s care plan.
  7. Use the appropriate technology. Many of your check-ins with patients can take place via phone or video calls. For more effective care, your team should also use the electronic health record (EHR) to record all necessary information about a patient’s health. You may also elect to use other software, like TimeDoc Health, to stay up-to-date with the needs of the patients and to remain compliant with program requirements.
  8. Analyze the effectiveness of the program and make any necessary changes. Monitor the health status of patients involved in the program as well as the patients’ engagement in the program. If your program does not maintain compliance or meet your goals, take steps toward adjusting workflows.

If any of this seems daunting to you, you have no need to worry. TimeDoc Health will fill in any gaps in your CCM program.

Supplement Your CCM Program With TimeDoc Health

TimeDoc Health provides the necessary platform and services for you to run a successful CCM program—particularly one for Medicare patients. In addition to providing trained care coordinators to work alongside your care teams, we also offer a platform that easily integrates with the tech systems you already use on a daily basis, such as the EHR. What’s more, we can assist both you and your patients with scheduling appointments, medication reconciliation, durable medical equipment assistance, and so much more.

To learn more about how we can supplement your CCM program, schedule a demo.