Chronic Care Management Service Offering Presentation TNMS.pdf · Chronic Care Management Service...

Chronic Care Management Service Offering“Unprecedented Revenue Share, We Get Paid When You Do.”

Copyright © 2016 CareVitality, Inc. All Rights Reserved

About Your Speaker

Vanessa Rose Bisceglie MBA, B.S., NCP, PMP, CMCOPresident of CareVitality, Inc.▪ Vanessa personally takes part in all research and consultancy given by her team of qualified staff.

She brings together EHR / Practice Management / Patient Portal consultants, legal counsel, IT professionals, social media/marketing professionals, insurance carriers, and software vendors.

▪ Her experiences in Healthcare IT ranges from EHR & Practice Management systems, Clinical Decision Support, Analytics, ACOs, HIEs, PQRS, SAFER Guides, Price Transparency, Patient Portals, Mobility, Telehealth, Compliance and HIPAA Privacy/ Security Assessments & Mitigation Plans.

▪ 20 years of Total Healthcare Experience: 6 years of clinical experience and 15 years of healthcare IT experience has included involvement in every aspect of the sales process and implementations for top ambulatory and hospital vendors. Vanessa received her Bachelors in Biology with a Minor in Chemistry & Ethics and an MBA in Healthcare IT, Marketing and Management, with honors in the top 5th percentile of all MBA students nationwide from Loyola University Graduate School of Business.

▪ Scored in the top 25% of MCAT test takers in the sciences and was accepted to several prestigious medical schools. Her background in legal class work emphasized contract law and medical malpractice defense led her to work for Ruff, Weidnaar & Reidy (medical malpractice defense firm).

▪ Currently, she is pursuing her second Masters in Analytics from the University of Chicago. In 2014, Vanessa has been voted as one of the Technology Woman Leaders in Chicago by TechWeek. Vanessa’s passion is to help physicians in every aspect of their IT related needs: creating efficiencies, increasing revenue and ultimately saving lives.

CEO, President of CareVitality, Inc.

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Presenter

Presentation Notes

I bring to the industry a unique background with experience in life sciences, clinical, legal and also having worked directly for vendors who developed CPOE, EHRs, HIEs, etc. I have over 14 years experience in HIT and was recently recognized by Chicago Tech Week and awarded one of the Technology Women Leaders in Chicago


About Us

Overview▪ Founded in 2009▪ Privately Owned Certified Woman Owned Business▪ HIT consulting and Care Management firm providing services &

solutions to physician groups, hospitals, payers, software, private equity, hedge funds, investment firms, etc.

▪ Headquartered in Chicago with multiple offices across the USA▪ Dedicated to improving technology in healthcare organizations.▪ Partnered with Renowned Industry Leaders

Corporate Office The Merchandise Mart222 Merchandise Mart Plaza12th Floor, Chicago, IL 60654

Southeast Coast OfficeCharleston, SC Office4000 Faber Place DriveNorth Charleston, SC 29405

West Coast OfficeNewport Beach, CA Office5000 Birch Street, Suite 3000Newport Beach, CA 92660

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Presenter

Presentation Notes

Our company is just over 6 years old, headquarterd in Chicago with two additional offices one on the east coast and one on the west coast


§ Highlight the current challenges surrounding the care for patients with chronic diseases

§ Understand Medicare’s requirement for the new CCM program and reimbursement code

§ Learn how healthcare organizations can improve quality of care for their patients and increase revenue by participating in the CCM program

§ Discover service offerings that can help your healthcare organization leverage this program to gain the most revenue

Objectives


Partnered/ Endorsed by Industry Leaders


Chronic disease patients our typically solely responsible for managing their health conditions and therefore create gaps in their care coordination and continuum of care

Gaps in care create/effect:

• Disparate health information about the patient

• Inaccurate medication reconciliation

• Increased morbidity and mortality

Medicare has recognized these challenges and has created the Chronic Care Management Program to combat these issues

The Research continued


Chronic Care Management Services

The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending. Beginning January 1, 2015, Medicare pays separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. CPT 99490 is defined as follows:

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Examples of Chronic Conditions

Tobacco Use Blindness & Visual Impairment Chronic Pain & Fatigue Obesity AnemiaCancer (almost all cancers) Deafness & Hearing Impairment Acquired Hypothyroidism Stroke AsthmaGlaucoma Cataract Acute Myocardia Infarction Epilepsy AutismTransverse Myelitis Arthritis (Rheumatoid & Osteo) Hip/Pelvic Fracture Schizophrenia DiabetesIntellectual Disabilities Autism spectrum disorders Hyperlipidemia Bipolar COPDSpina Bifida Mobility Impairments Personality Disorders Anxiety FibromyalgiaChronic Kidney Disease Heart failure Multiple Sclerosis ADHD Atrial FibrillationHypertension Ischemic heart disease Learning Disabilities HIV/ AIDAOsteoporosis Migraine/Chronic Headache Multiple Sclerosis DepressionSpinal Cord Injury Liver Disease/ Cirrhosis Pressure/ Chronic Ulcers PTSD Muscular Dystrophy Peripheral Vascular Disease Cerebral Palsy Hepatits

Remember new conditions are being added as CMS has elaborated on the definition of a Chronic Conditions:

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Presenter

Presentation Notes

Our mission is to improve the delivery and quality of healthcare by implementing technology solutions


Practitioner Eligibility

§ Certified Nurse Midwives

§ Clinical Nurse Specialists

§ Nurse Practitioners

§ Physician Assistants

NOTE: Eligible practitioners must act within their State licensure, scope of practice, and Medicare statutory benefit. The CCM service may be billed most frequently by primary care physicians, although specialty physicians who meet all of the billing requirements may bill the service. The CCM service is not within the scope of practice of limited license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, therefore these practitioners cannot furnish or bill the service. However, CMS expects referral to or consultation with such physicians and practitioners by the billing practitioner to coordinate and manage care.

Only one practitioner may be paid for the CCM service for a given calendar month

Physicians and the following non-physician practitioners may bill the new CCM/TCM services:

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Supervision of the Programs

Services provided directly by an appropriate physician or non-physician practitioner, or byclinical staff incident to the billing physician or non-physician practitioner, count toward the minimum amount of service time required to bill the CCM service (20 minutes percalendar month).

Non-clinical staff time cannot be counted. Consult the CPT definition of “clinical staff” andthe Medicare PFS “incident to” rules to determine whether time by specific individuals maybe counted towards the minimum time requirement. Practitioners may use individuals outside the practice to provide CCM services, subject to the Medicare PFS “incident to” rules and regulations and all other applicable Medicare rules.

NOTE: CMS provided an exception under Medicare’s “incident to” rules that permits clinical staff to provide the CCM service incident to the services of the billing physician (or other appropriate practitioner) under the general supervision (rather than direct supervision) of a physician (or other appropriate practitioner).

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Patient Consent (CCM Program)

Consent Requirements

The Practitioner billing for CCM must gain consent during an encounter. Once consent has been obtained it must be placed indexed in the Patients Chart in the EHR.

Patient consent requirements include:

§ Patients have to be informed about the CCM program and services and that their medical information will be shared among their providers and available to them or their care giver 24/7

§ Explain how to revoke the service.§ Inform the patient that only one practitioner can furnish and be paid for the service

during a calendar month

Although patient cost-sharing applies to the CCM service, CCM may help avoid hospitalizations, procedures or surgeries in the future by proactively managing patient health, rather than only treating disease and illness.

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Scope of Services Under CCM Program

Scope of CCM Services are Extensive and Require ALL of the following:

EHR and Other Electronic Technology Requirements: CMS requires the use of certified EHR technology to satisfy some of the CCM scope of service elements. *Must be 2014 Certified EHR

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Presenter

Presentation Notes

The CCM service is extensive, including structured recording of patient health information, an electronic care plan addressing all health issues, access to care management services, managing care transitions, and coordinating and sharing patient information with practitioners and providers outside the practice. Some of the CCM Scope of Service elements require the use of a certified EHR or other electronic technology. For a complete listing of the CCM Scope of Service elements and electronic technology requirements that must be met in order to bill the service.


Yes, there are four:§ Transitional care management (CPT 99495 and

99496)§ Home healthcare supervision (HCPCS G0181)§ Hospice care supervision (HCPCS G0182)§ Certain end-stage renal disease (ESRD)

services (CPT 90951-90970)

ARE THERE SERVICES YOU CAN’T BILLFOR AT THE SAME TIME AS CCM?


Scope of Services Under TCM ProgramTransition back into the Community The services are required during the beneficiary’s transition to the community setting following particular kinds of discharges: Inpatient Acute Care Hospital, Inpatient Psychiatric Hospital, Long Term Care Hospital, Skilled Nursing Facility, Inpatient Rehabilitation Facility, Hospital outpatient observation or partial hospitalization; and Partial hospitalization at a Community Mental Health Center

Scope of Services Under TCM Program

Requirements for TCM

Scope of Services Under TCM ProgramAccepting Care of the Beneficiary ▪ The health care professional accepts care of the beneficiary post-discharge from the facility setting

without a gap▪ The health care professional takes responsibility for the beneficiary’s care; and▪ The beneficiary has medical and/or psychosocial problems that require moderate or high complexity

medical decision making.▪ The 30-day TCM period begins on the date the beneficiary is discharged from the inpatient hospital

setting and continues for the next 29 days

Scope of Services Under TCM ProgramBeneficiary Must Be Returned To One of These SettingsHis or her home; His or her domiciliary; A rest home; or Assisted living

Scope of Services Under TCM ProgramTCM Services FurnishedInteractive contact W/I 48 hours of discharge, non-face-to-face activities & face visit (W/I 7/14 days)

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THE NEW CHRONIC CARE MANAGEMENT PROGRAM:OPPORTUNITY FOR ADDITIONAL REVENUE

What’s it worth to you potentially?

§ Per the MGMA Cost Survey for Single specialty practices: 2013 report Based on 2012 data specific to the specially of family medicine includes Medicare A/B and Medicare Advantage

§ CMS gov – Country Level Multiple Chronic Conditions (MCC) Table 2012 prevalence, National Average.§ Reimbursement amount from the CY 2015 Physician Fee Service Final Rule: assumes 100% of unique patients are covered by Medicare Advantage

may vary

Presenter

Presentation Notes

Please make the $306,720.00 stand out more, can you try to match it closer to our PDF brochure I sent you?


So Why Isn’t Everyone Participating?

According to recent surveys, many Providers are missing out on a large Revenue Opportunity!

Recent Online Survey Revealed

About 35 Million Medicare Beneficiaries are eligible for the Program, but only 100,000 are Participating!

17%

31%

52%

Survey

I have alreadylaunched a CCMProgram

I am not planning toparticipate in theProgram

I plan to launch aCCM Program in thenext year

Reasons for Not Participating

Burden of documenting time

Burden & Cost of Hiring Resources

Fear of Medicare Penalties

Presenter

Presentation Notes

We have a comprehensive suite of service offerings tailored specific to improving health outcomes and increasing productivity in Provider organizations, while also providing services to safeguard their practices against the pitfalls of technology related to security.


Why Providers Should Be Participating?

RevenueUnprecedented

Revenue Opportunity (Paid Monthly)

Work/Life Balance Medicare Patients

require a lot of Time and Resources

Improve Quality Measures

Improve the Health of Your Chronically Ill Patients and Reap the Added Benefits

Patient SatisfactionBy providing better care and more engagement, patients are more satisfied

Presenter

Presentation Notes



The Benefits of CCM

Providers

• Improved Care Coordination

• Improved patient compliance

• Medication management /monitoring

• Care Plan management/monitoring

• Increased Revenue and patient appointments

Patients

• Decrease ER visits and hospital admittance

• Much needed support and health coaching

• Reinforcement of Care Plan adherence

• Improved quality of life


• 1 FTE for every 125-250 qualifying CCM patients

• Average cost per FTE to perform these services is $25 per hour

• Cost for Compliance and Liability

• Difficult Startup/Implementation Cost, include down time for practice

• Opportunity Cost for not onboarding all qualifying CCM patients

• Cost to train staff and more administrative burden

The Cost to do CCM In-house


Choosing a CCM/TCM Partner

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§ No PCMH requirement§ No annual wellness visit requirement - CMS strongly

recommends that a provider furnish an annual wellness visit (HCPCS G0438, G0439) or an initial preventive physical exam (G0402) to the beneficiary, there are no prerequisite services required to bill for CCM.

DO I NEED TO BE A PATIENTCENTERED MEDICAL HOME?

I AM PARTICIPATING IN AN ACO CAN I STILL BILL FOR CCM?

§ Yes


§ No. The Multi-Payer Advanced Primary Care Practice Demonstration (MAPCP), Comprehensive Primary Care (CPC and CPC+) Initiative both include payments for care management services that closely overlap with the scope of services for the new chronic care management services code. In these initiatives, primary care practices are receiving per beneficiary per month payments for care management services furnished for Medicare fee-for service beneficiaries attributed to their practices.

Can I bill for CPC, CPC+ and MAPCP as well as CCM for the same patient?

Presenter

Presentation Notes

https://innovation.cms.gov/initiatives/Multi-payer-Advanced-Primary-Care-Practice/index.html CPC model requires practitioners to use electronic health records that have been certified by the National Coordinator for Health Information Technology, provide patients with 24/7 access to the practice, ensure continuity of care with a designated practitioner or care team for each patient, provide care management that includes a systematic assessment of patient needs, use patient-centered care plans, and give enhanced opportunities for patient and caregiver communications. Similarly, the MAPCP demonstration is testing the patientcentered medical home model, which focuses on care management, continuity of care, and care coordination. All practitioners, who are voluntarily participating in these initiatives, receive quarterly reports indicating which beneficiaries have been attributed to their practices.


Additional Services Offered

Search & Selection System(s)

Contract Review & Negotiations

Project Management/Implementation/ Training/ Go-Live Support

HIPAA Privacy /Security Risk Assessment and Mitigation Plan / Encryption/ Policies & Procedures

EHR Optimization/ Template Customization/ Practice Workflow & Redesign

Meaningful Use Services (Gap Analysis & Attestation of all Stages)

PQRS Consulting

Mock Meaningful Use Audits (Prepares a Practice if audited for Meaningful Use)

Meaningful Use Audit & Appeals Consulting

EHR/EDR, Practice Management (Billing & Scheduling), Patient Portal and Telehealth Systems Services:

ICD-10 Education, Training & Consulting TBD

Presenter

Presentation Notes



Thank you for your time!

Vanessa Rose Bisceglie MBA, B.S, NCP, PMP, CMCO President

(800) 376-0212 [email protected]

Chronic Care Management Service Offering Presentation TNMS.pdf · Chronic Care Management Service...

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