Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM.

Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare's existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

In this 25-page resource, Debra Burbary, RN, clinical quality assurance manager with Arcturus Health, describes the steps that led to her organization successfully billing Medicare for an initial set of enrolled patients, with more beneficiaries joining Arcturus's CCM rolls each month.  

In Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue, Ms. Burbary covers the following topics:

• How CCM has helped Arcturus to extend its evidence-based, chronic care services;
• The importance of physician leadership to CCM success;
• Strategies for introducing patients to the CCM program and fostering engagement;
• Common CCM billing and implementation challenges, including the time and cost necessary to meet CMS documentation requirements for CCM;
• Leveraging CCM practices with other payors;
• Program expansion plans, including opportunities to extend CCM to the 2,300 Arcturus patients who may qualify for the year-old Medicare Chronic Care Management billing codes;

Table of Contents

• Leveraging Population Health Management for Successful Claims Submission
  • Chronic Care Costs and Potential Revenue
  • CCM Program and Technology Requirements
  • Patient Access and Assessment
  • Participation Agreement
  • Comprehensive Care Plan
  • Challenges of Time Documentation
  • Provider and Staff Engagement
  • Identifying Eligible Population
  • Introducing CCM to the Patient
  • Program Barriers
  • Year 1 Lessons and Feedback
• Q&A: Ask the Experts
  • Program Enrollment
  • Chronic Care Management Caseloads
  • Specialist Interactions
  • Recommended Timing for Billing Generation
  • Separating Transitional Care and Chronic Care Management Billing
  • Applying Technology to CCM
  • Resources to Support CCM Billing
  • Top CCM Conditions
  • Initial Billing Hurdles
  • Patient Feedback
  • Avoiding Care Coordination Overlap
  • CCM Impact on Non-Medicare Patients
  • Evaluating Other Care Management Programs
  • RN Health Assessment
  • Patient Authorization Agreement
  • CCM Functions via Patient Portal
• Glossary
• For More Information
• About the Contributors