Medicare Announces Plans to Expand Care Management Reimbursements in 2022

Beginning in 2015, CMS introduced reimbursements to pay for and incentivize doctors for the extra attention that chronic and fragile patient populations require. After discharge and between visits, these cohorts require significant time and activity devoted to extra care coordination, medication management, patient education and attention.

Starting with one “Chronic Care Management – 99490” payment for $42 in 2015, CMS has expanded these CPT codes to cover five different categories and 20 various monthly recurring reimbursements. The newest category, Remote Therapeutic Monitoring (RTM), covers the tracking of non-physiologic patient data such as pain, musculoskeletal system status, respiratory system status, therapy and medication adherence and medication response.

An astounding 99% of all Medicare payments are made on behalf of chronic patients. So, it makes sense that the government would want better outcomes – and be willing to pay to get them. Since small and independent practices are already known for providing the bulk of chronic care, the move translates into greater reimbursement for work they’re already doing.

Care management solutions unlock the ability for practices to earn additional reimbursements for the services they already provide to chronic care patients. For more information on this topic, check out the recording with this topic and more here.

How can practices be reimbursed for care management?

It boils down to tracking the ‘non-face-to-face time’ your staff spends performing tasks for chronic patients. New care management software options electronically keep tabs on patients between visits and automatically tracks and documents the care management activities that qualify for reimbursement.

Care management activities such as:
  • medication refills and changes
  • lab and test result reviews
  • communications with team members
  • and phone calls with your patients and their care givers

Software options also plug into the phone system to log the time spent on care coordination and patient calls.

Reimbursements start at $42 per patient, per month but can earn as much as $265 per patient, per month, based on the cumulative time spent with the patient each calendar month.

How does care management work?

Integrated solutions work on top of Kareo to electronically prompt patients with questions about risks and symptoms associated with their problem list.

Here is how it works:
  • When responses trend negative or exceed clinical thresholds, practice staff are alerted.
  • Earlier intervention is documented to reduce hospitalizations and slow disease progression.
  • The time spent monitoring is added to the time practices already spend on the phone with or on behalf of patients, as well as the care management activities they perform inside of Kareo.

The results are that small and independent practices can deliver a higher level of care—and earn significantly greater revenue—without adding significant overhead or third-party services.

The other key to successful and sustainable care management is patient engagement. Automated “push” messages are sent to patients daily, asking about their status and updating a practice dashboard. Status is summarized on a color-coded dashboard, for speedy identification of trends and at-risk conditions. Providers know at one glance which patients need attention and can intervene appropriately. This level of monitoring not only eases the management of complex patients and reduces phone calls, but also counts towards Medicare’s care management reimbursements.

What are other benefits?

Studies show that there are many benefits to proactive chronic care management including:
  • reduced hospitalizations, readmissions, as well as visits to urgent care and emergency departments
  • improved preventative care
  • strengthened patient relationships by reducing their anxiety and increased satisfaction

You’ll also notice fewer inbound phone calls, less work around hospitalizations and emergency room visits, and improvements in the care your practice provides—while financially strengthening it. Care Management gives practices the alerts needed to manage chronic disease while empowering providers to provide proactive care.

Want to learn more?

For more details on this important topic and product, join us for our upcoming webinar on How to Drive Reimbursements and Proactive Treatment with Care Management. This is a free webinar hosted by Kareo on Wednesday, September 22, 2021 at 1:00 pm ET / 10:00 am PT. Terri Joy, Kareo’s billing subject matter expert, will be joined by Matt Ethington, founder, and CEO of ChronicCareIQ, to explain the ins and outs of this important opportunity.

You can visit the ChronicCareIQ website to learn more about their integrated Kareo solution 

About the Author

Alesa Lightbourne is a prize-winning author, professor and former dean of an international business school. As a freelance writer, her clients have included Fortune...

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