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Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results
Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results
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A profitable by-product of CMS's aggressive pursuit of value-based healthcare delivery is a menu of revenue opportunities associated with care management of the Medicare population.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning. 

In this 23-page special report, Robert Fortini, PNP, chief clinical officer for Bon Secours Medical Group, describes how his organization, an early proponent of embedded nurse navigators, optimizes workflows, documentation and data analytics to elevate clinical outcomes and value-based reimbursement for each Medicare billable event. 

This report showcases each Medicare care management revenue opportunity, detailing the following:

  • BSMG's Next Generation Healthcare initiative, defined by Fortini as 'population health meets total access' and the platform for Medicare billing success;
  • The organization's road to population health management and successful strategies deployed along the way;
  • A half-dozen BSMG solutions improving access to care, from retail clinics embedded in supermarkets to BSMG's MyChart® patient portal;
  • The focus of smart care teams on specific population segments and development of key BSMG workflows;
  • The use of point-and-click smart tools to create purposeful electronic documentation and care plans for billable events;
  • 'Smart tool' use embedded nurse navigators in documentation of Transition of Care codes;
  • Development and documentation of comprehensive plan of care and related workflows for Medicare beneficiaries enrolled in CMS's Chronic Care Management program;
  • Application of smart tools for three types of Medicare annual wellness visits;
  • Outcomes from transitional care management, chronic care management and Medicare annual wellness visits;
  • BSMG's participation in a Virginia Advance Care Planning initiative and future expansion plans;
and much more.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results also features details on BSMG's care planning script use, skill sets, assessment tools, lessons learned and other key topics.

Table of Contents:

  • Value-Based Workflow Optimization for Chronic Care Management and Advance Care Planning
    • 6 Population Health Strategies
    • Access Solutions
    • Smart Care Teams
    • Transitions of Care
    • Navigator Documentation
    • Chronic Care Management
    • Care Plan Documentation
    • Annual Wellness Visits
    • Results from CCM, Transitions of Care and Annual Wellness Visits
    • Advance Care Planning
  • Q&A:
      PCP Role in Chronic Care Management
    • Readmission Risk Factors
    • Patient Consent Script
    • Readiness to Change Tools
    • Documenting the 20-Minute Requirement
    • Digital Health Use
    • CCM Virtual Visits
    • Skill Sets for CCM, Transitional Care and Advance Care Planning
    • Patient Contribution to Care Plan
    • ACO Participation
    • Lessons Learned
    • Boosting Annual Wellness Visit Metrics
    • Overcoming CCM Barriers
  • Glossary
  • For More Information
  • About the Contributor
Publication Date: June 2016
Number of Pages: 23
ISBN 10: 1-943542-18-X (Print version); 1-943542-19-8 (PDF version)
ISBN 13: 978-1-943542-18-5 (Print version); 978-1-943542-19-2 (PDF version)
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