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Format: On-Demand Webinar
Presenter: Dr. Irina Koyfman, DNP, NP-C, RN
Time: You can access the webinar anytime
Duration: 60 minutes
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Providers spend a significant amount of time in between visits managing their most complicated, chronically ill patients without reimbursement. All that changed in 2015, when Medicare began paying for CCM services (CMS, 2019). However, many providers still choose not to participate in CCM due to multiple layers of complicated requirements. According to the Center for Medicare and Medicaid Services (CMS), it is estimated that only 9% of Medicare fee-for-service beneficiaries received the Chronic Care Management, Transitional Care Management, and Advance Care Planning services. CMS acknowledged that those codes are being underutilized and encouraged providers to get more involved with them (2019). The most significant changes happened in 2022 when CMS dramatically increased CCM reimbursement. This presentation will demystify the complexity of the process. We will discuss each required element for CCM billing. We will showcase how CCM applies to the quadruple aim by increasing patients and provider satisfaction, reducing the cost of care, and increasing the quality of care.

Learning Objectives:

  • Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements
  • Examine the Scope of Services required to bill Medicare for CCM services
  • Identify how CCM can close care gaps and engage patients
  • Assess the financial and quality implications of incorporating CCM in your practice
  • Recognize the importance of CCM in relation to quadruple aim

Areas Covered in the Session

  1. Objectives
    • Review CMS’s Chronic Care Management (CCM) requirements
    • Review CMS’s Principal Care Management (PCM) requirements
    • Examine Scope of Services required to bill Medicare for CCM services
    • Identify how CCM can close care gaps and engage patients
    • Assess financial and quality implications of incorporating CCM in your practice
    • Recognize the importance of CCM in relation to quadruple aim
  2. CCM overview
    • Elements of CCM
    • Patients’ eligibility
    • Chronic conditions examples
    • Provider Responsibilities
      • Initiate Visit for every patient who has not been seen in the past year.
      • Use Certified EHR Technology
      • Provide 24/7 Access & Continuity of Care
      • Obtain Patient’s Consent
      • Establish, Monitor and Revise the Comprehensive Care Plan
      • Management of Care Transitions
      • Coordinate Home- and Community-Based Care
      • Provide Comprehensive Care Management
      • Spend At least 20 MINUTES non-face-to-face time monthly
    • Activities included in 20 MINUTES non-face-to-face time monthly
    • Care Plan
      • Problem list
      • Expected outcome and prognosis
      • Measurable treatment goals
      • Symptom management
      • Planned interventions and individuals responsible for each intervention
      • Medication management
      • Community/social services ordered
      • Interaction and coordination with outside resources and practitioners and providers
      • Schedule for periodic review and, when applicable, revision of the care plan
    • Reimbursement
      • Can and Can’t bill with the CCM
      • All CPTs codes with explanations
      • Potential financial gains
  3. Benefits of CCM
    • Patients’ satisfaction
    • Provider satisfaction
    • Reduced healthcare cost
    • Increased quality of care
  4. References

Suggested Attendees

  • Nurses
  • Doctors
  • Nurse Practitioner
  • Population Health Officers
  • Innovation officers
  • CNO/CMO
  • Billers
  • PCP (MD, NP, PA)
  • Specialists (MD, NP, PA)
  • Nurse Managers
  • C-Suite Healthcare Executives

About the Presenter

Dr. Koyfman is an enthusiastic and emotionally intelligent Nurse Practitioner with 20 years of nursing and 15 years of executive experience with excellent communication skills. She presents with a sense of humor and practical examples. Dr. Koyfman is an expert in Patient-Centered Medical Home (PCMH), Home Health, Healthcare startups, Transitional Care, Community Health, Chronic Care Management, and Care Coordination. She is considered a Subject Matter Expert in Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) and has been consulting in the space of remote patient management for many years.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
    00:00
  • Course Key
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