GE Healthcare Camden Group Insights Blog

Medicare Now Reimburses Physicians for Chronic Care Management

Posted by Matthew Smith on May 28, 2015 2:31:00 PM

Care coordination is a cornerstone of value-based healthcare. It is especially important for patients with chronic diseases, who require complex health services and careful tracking.

Under healthcare reform, physicians have increasingly been expected to provide better care coordination. The problem is that they have received no payment for coordination services not delivered face-to-face. That is now changing thanks to a recent Centers for Medicare and Medicaid ("CMS") decision.

As of January 1, 2015, Medicare pays physicians separately for chronic care management ("CCM") services. This is a potential game-changer for provider organizations transitioning to value-based care. The new policy will help medical practices fund the resources needed to provide care coordination. It can also let organizations leverage quality to strengthen bottom-line income.

Implementing Care Management

In the 2015 Medicare Physician Fee Schedule, CCM services are billable under CPT code 99490. Reimbursement is approximately $43 per patient per month. To be eligible for the payment, services must meet several conditions:

  • Patients: Patients eligible for CCM services must have 2 or more chronic conditions expected to last at least 12 months. These conditions must place the patient at “significant risk of death, acute exacerbation/decompensation, or functional decline.” Patients must provide written consent for CCM services.
  • Parameters: Patient CCM services must take at least 20 minutes of clinical staff time per calendar month. Staff must establish, implement, revise, and monitor a comprehensive care plan. Patients must have 24/7 access to care management staff.
  • Providers: CCM services must be performed by a physician, a non-physician practitioner, or another clinical staff member supervised by a qualified health care professional (under Medicare’s “incident to” rules).

Significant Revenue Opportunity

According to the Centers for Disease Control, two-thirds of Medicare beneficiaries have two or more chronic conditions. As a result, healthcare organizations of every size stand to benefit from the new payment policy.

Consider a solo physician with 500 Medicare patients. Statistically, about 333 of these patients will have multiple chronic diseases. Depending on how many patients qualify for CCM and agree to receive these services, the physician could generate $100,000 or more in additional annual reimbursement.

To realize the full potential reimbursement, providers must meet several requirements. Patients must first agree in writing to receive CCM services. In addition, the practice must meet all documentation requirements, including documentation of staff time.

Care management can create additional costs, including staffing and IT costs and other general expenses. That is why this new payment policy is a great opportunity for organizations that have already built a care management program, such as many acountable care organizations, integrated delivery networks and even some larger medical groups.

For example, consider a health system that already provides care management services for select patient populations. The system has 100 employed physicians who manage patients with chronic conditions. With modest changes to comply with service and documentation requirements, the system could be eligible for several million dollars in new reimbursement for CCM services.

The opportunity for all healthcare organizations is to strengthen the bottom line while providing better care. CCM services can help lower complication and readmission rates, which will ultimately lower the cost of care for patients and payers. 

Careful Planning Needed

To successfully implement CCM, provider organizations need to focus on three priorities:

  • Hiring and organizing clinical staff to orchestrate patient care and manage patient populations.
  • Implementing technology that enables the sharing of patient data among providers, tracking clinical quality measures, and maintaining electronic care plans.
  • Developing effective processes for coordinating care, reconciling medications, managing care transitions, and attaining other CCM goals.

Achieving these goals requires careful planning. But qualifying for CCM reimbursement can help many healthcare organizations transition successfully to value-based care.

Topics: Medicare, Reimbursement, Lucy Zielinski, Chronic Care Management

Free Practice Management Breakfast Seminar for Independent Physicians & Staff: February 20th | Suburban Chicago

Posted by Matthew Smith on Feb 19, 2014 11:25:00 AM

Independent Physician AdvisorsJoin the Independent Physician Advisors tomorrow, Thursday, February 20th at 7:30 am in Oakbrook Terrace for a complimentary breakfast and seminar, Profitable Practices: Overcoming the Unpredictability of Reimbursement.

Topics to be Covered Include:

  • Impact of ICD-10
  • E/M Coding Challenges
  • Minimizing Denials & Collections
  • Increasing Patient Satisfaction

Presented by:

Bradley A. Netzel

Deena Wojtkowski
Associate VP of Client Services, ebix, inc.

Tony Moscato

Tony Muscato
VP/Owner, Creditor's Discount & Audit Company


7:30am    Hot Breakfast & Networking
8:00am    Presentation 
9:30am    Q&A and open networking


Redstone American Grill
13 Lincoln Center
Oakbrook Terrace, IL 60181
(630) 268-0313


Independent Physicians, Practice Management


This event is complimentary, however advanced registration is required. We ask that attendance be limited to independent physicians and their office staff.

To register for this event, please click the button, below. In the box marked, "How did you hear about this seminar?" please enter: Health Directions Blog.

Topics: Reimbursement, ICD-10, Coding, Denials, Collections, Independent Physician Advisors, Patient Satisfaction

HD to Present on ACO Risk-Based Contracting at HFMA ANI2013

Posted by Matthew Smith on Jun 18, 2013 11:37:00 AM

HFMA, ANI2013, Health Directions, Dan Marino

Health Directions President/CEO, Daniel J. Marino, takes to the podium Wednesday morning alongside Asad Zaman, MD, to discuss risk-based contracting at HFMA's ANI2013 in Orlando, FL. 

Their presentation, titled A Practical Approach Toward Accountable Care and Risk-Based Contracting: From Design to Implementationshares advanced strategies and lessons from a large health system's experience in creating an accountable care enterprise. Participants learn how to develop critical financial systems and integrate them with clinical programs and technology initiatives to position for value-based reimbursement. The presentation covers financial performance indicators, clinical quality measures, clinical integration strategies and key technology resources. Attendees learn to combine clinical outcomes measures with claims data to track the cost of care and position.

A Practical Approach Toward Accountable Care and Risk-Based Contracting: From Design to Implementation (F04) 1.5 CPEs

Wednesday, June 19, 2013 10:00 -11:15 a.m.

Topic Area:
CFO/Executive Leadership

After this session, you will be able to:

  • Plan clinically integrated programs that reduce costs and improve outcomes
  • Establish clinical and financial measures for organizational accountability
  • Combine clinical outcomes measures with claims data to track the cost of care
  • Promote value-based coordinated care and negotiate accountable care contracts using risk-based, value purchasing, or performance-based models


Familiarity with reimbursement models, health IT systems, evidence-based medicine, and population health; general knowledge of accountable care, clinical integration, and risk-based managed care contracting

Tools and Takeaways
Sample metric reports for managing accountable care initiatives and examples of clinical integration goals with performance measures for multiple stakeholders, supporting technology and processes, outcomes, and contractual incentives

Asad Zaman, MD
Chairman, Internal Medicine Department
Advocate South Suburban Hospital

Daniel Marino, MBA, MHA
President and CEO
Health Directions LLC

Topics: Accountable Care, ACO, Reimbursement, Risk-Based Contracting

Top 10 Challenges Facing Medical Practice Group Leaders

Posted by Matthew Smith on Sep 5, 2012 11:33:00 AM

10 ChallengesMedical practice professionals responding to MGMA-ACMPE's fifth annual medical practice survey discussed some of the most glaring issues group practices face today.

Here are the top ten challenges noted from the survey of more than 1,250 respondents.

  1. Managing finances with the uncertainty of Medicare reimbursement rates.
  2. Preparing for reimbursement models that put greater financial risk on practices.
  3. Preparing for the transition to ICD-10.
  4. Dealing with rising operating costs.
  5. Participating in CMS' electronic health record meaningful use incentive program.
  6. Understanding the total cost of an episode of care from the perspective of the payor.
  7. Collecting payment from high-deductible health plans and/or health savings account patients.
  8. Maintaining physician compensation levels.
  9. Managing group practice finances.
  10. Recruiting physicians.

In today’s challenging healthcare environment, medical practices that lack effective management controls quickly develop problems in patient service, financial performance, and physician and staff satisfaction. While they try their best to meet these practice demands, many practices simply lack adequate knowledge of their inefficiencies.

Health Directions works with physician practices so they gain control of the business side of their medical practices. By working cooperatively with providers and office staff, Health Directions enables practices to overcome difficult challenges and identify new opportunities.

The Health Directions team members rely on their hands-on experience managing both independent and hospital-owned practices. We use our practical expertise to augment current and/or provide temporary leadership in support of long-term solutions.

Specifically, Health Directions provides the following Practice Management services:

  • Practice start-up: Health Directions coordinates every aspect of practice development: staffing, technology, clinical operations, patient flow, business office processes, revenue cycle management and managed care contracting.
  • Practice turnaround: We provide the hands-on leadership needed to reduce staff turnover, improve the patient experience, boost physician satisfaction and achieve strong profitability.
  • Interim management: Our team members provide outstanding value by using interim management to address longstanding practice issues, guide organizational transitions and consolidate operational improvements.
  • Medical practice assessment: Health Directions reviews the operational and financial aspects of the practice, including staffing, workflow, systems, billing and collections. By gathering data, interviewing key staff, observing workflow and analyzing reports.
  • Practice Education: Health Directions leads and executes practice retreats and workshops aimed at improving operations, enhancing collaboration, and building market share. To augment day-to-day practice operations, Health Directions offers a range of half-day sessions pertaining to effectivepractice management.

Let Health Directions work with you to develop efficient practice operation and increased cash flow while you advance the quality care of your patients and strategically position your practice for future growth. 

Simply click on the button below to receive our complimentary Practice Pulse checkup that will deliver estimates identifying:

  • Amount of increased practice revenue per year
  • Amount of increased collections per year
  • Amount of increased patient volume
  • Amount of reduced operational costs
Strategic Provider Planning, Specialty Mix

Topics: EHR, Meaningful Use, Medicare, Reimbursement, Physician Recruitment, ICD-10, Operating Costs, Revenue Cycle

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