By Laura Freeman

Chronic Illnesses take a toll. The price patients pay can be years of pain, diminished quality of life, damage to other organs, early death and the burden of medical bills and medication.

There is also a cost that providers pay. Chronic conditions increase the demands on staff time that in the past were usually written off as overhead. Someone has to set up referrals to specialists, rehab and other allied health support, deal with requests for medication refills and check to see that post-discharge patients are doing well and their needs are being met after hospitalization. Getting prior approval for procedures and specialty medications can take a while. After returning patient calls, delivering routine test results and answering questions, it can be difficult to find time for proactive efforts to help patients get ahead of their illness and get better control of their condition. 

The tendency of some chronic conditions to increase the risk for others multiplies the problem and the staff time required to manage care for each patient. Fortunately, providers can now recover some of these costs for Medicare patients who meet approval criteria.

“When Medicare patients have two or more of the high risk chronic conditions on the list, 20 minutes of documented office staff time each month can be billed at $60 under code 99490, with up to $130 for additional documented time per month,” said internal medicine specialist Muhammed E. Ata, MD. “This isn’t physician time. It’s time your staff is already using to manage a patient’s care for these chronic conditions under a physician’s supervision. If your practice has 250 Medicare patients who qualify for $60 reimbursement each, that would be $15,000 to put toward your overhead each month. That amount could make quite a difference in how well a practice is doing at the end of the year.”

To simplify the process of gathering the structured documentation needed to submit a claim for comprehensive care management (CCM) Ata helped to develop a software program known as EZCare CCM.

“In addition to making documentation easier, the program has features that can actually help you improve patient satisfaction and help your patients get better control of their condition,” he said. “For example, one capability that goes beyond what most systems offer is a bulk messaging feature that allows you send out one message to hundreds of patients at once rather than having to make a hundred phone calls. When a new diabetes medication comes on the market, your patients are likely to hear about it and have questions. You can send one message to all of them explaining the benefits of the drug, along with any potential drawbacks.

“This makes patient teaching and proactive efforts much easier. When you have a holiday coming up that you know is going to be challenging for patient compliance, you can offer them encouragement to help them choose the right food and take care of themselves. You could even send out recipes for diabetes and blood pressure-friendly versions of holiday recipes so they can enjoy their favorites without feeling deprived.”

In addition to better outcomes, this upgrade in chronic care management could also help to reduce hospital readmissions and emergency room visits, which in some cases could result in better reimbursement rates for other care services.

The messaging capability can also be used as a teaching tool for newly diagnosed patients to help them become accustomed to taking care of themselves, and to learn about their medications and when and how to take them.

“In our office we have care coordinators who work with patients and with other providers and support to help them,” Ata said. “They build strong relationships. Patients become more comfortable asking them questions or reporting minor changes that can be early clues so that developing problems can be identified before they become more serious. The managers can also note issues that may need follow-up in the patient’s chart so they won’t get sidetracked by other issues in the next visit.”

Internal medicine, primary care, mental health practices and other providers can file a CCM claim, but only one practice per month can file for the CCM Medicare benefit for any one patient, and patients should be signed up for comprehensive care management.

“One of the best things about this CCM tool is that it helps us help our patients stay healthier,” Ata said. “Many chronic conditions are progressive and can put a burden on the rest of the body. Suddenly, instead of just hypertension or diabetes, you have kidney disease, congestive heart disease or a stroke. If you can get good control of the hypertension early, you can make a huge difference in a patients overall health.

“Getting reimbursed for the care management time you are now writing off can also make a big difference in the financial health of a medical practice. If providers or practice managers want to know more about the EZCare CCM LLC software, they are welcome to email me at support@EZHorizon.com.”