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athenaOne

The athenaOne Suite which includes athenaCollector a revenue cycle management solution and athenaClinials an EHR (electronic health records) recently ranked #1 in 2023 Best in KLAS for athenaClinials Ambulatory EMR for 11-75 physi...Read more about athenaOne

3.8 (853 reviews)

278 recommendations

RXNT

RXNT’s cloud-based, ONC-certified medical software—Billing, Practice Management, EHR, and more—improves clinical outcomes & revenue cycle management. Simple, transparent pricing includes free setup and training, free data transfer...Read more about RXNT

4.3 (453 reviews)

255 recommendations

DrChrono

DrChrono’s iPad and iPhone compatible EHR and medical billing platform allows medical practices and healthcare providers to manage patient intake, patient care, clinical charting, billing and revenue cycle management. It includes ...Read more about DrChrono

4.0 (482 reviews)

221 recommendations

AdvancedMD EHR

AdvancedMD is a unified suite of software solutions designed for mental health, physical therapy and medical healthcare organizations and independent physician practices. Features include practice management, electronic health rec...Read more about AdvancedMD EHR

3.6 (455 reviews)

155 recommendations

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NextGen Office

NextGen Office is an award-winning, cloud-based, clinical and billing solution designed for smaller, independent practices (≤ 10 providers). This all-in-one, full-service solution includes specialty-specific EHR content, an easy-t...Read more about NextGen Office

4.0 (1264 reviews)

74 recommendations

ChartLogic EHR

ChartLogic offers an ambulatory EHR suite that includes electronic medical record, practice management, revenue cycle management, e-prescribing and patient portal. The solution caters to primary care, surgical care and other compl...Read more about ChartLogic EHR

3.8 (64 reviews)

71 recommendations

CureMD

CureMD is a certified cloud-based EHR, practice management, patient portal and revenue cycle management. CureMD helps physicians and office staff manage their practice operations. It also helps practices adopt Meaningful Use - dri...Read more about CureMD

3.4 (66 reviews)

29 recommendations

Compulink Healthcare Solutions

Compulink Advantage is an all-in-one database EHR solution for specialty practices such as optometry, ophthalmology, orthopaedics, ENT, mental health, podiatry, and more. Available cloud-based or server, Advantage includes smart f...Read more about Compulink Healthcare Solutions

4.0 (284 reviews)

22 recommendations

Psychiatry-Cloud

Psychiatry-Cloud by WRS Health is a cloud-based integrated electronic health records (EHR) solution that offers integrated practice management, billing services, and marketing services for psychiatrists, therapists, social workers...Read more about Psychiatry-Cloud

4.2 (15 reviews)

22 recommendations

NextGen Enterprise

NextGen Healthcare provides scalable, integrated solutions and professional services to help your practice administer excellent care and operate your business more efficiently. We serve medium to large enterprise-level ambulatory ...Read more about NextGen Enterprise

3.9 (11 reviews)

20 recommendations

AllegianceMD

AllegianceMD is a cloud-based medical software system that is designed to serve the needs of small and midsize practices, as well as ambulatory surgery centers. The solution includes practice management functionality for billing a...Read more about AllegianceMD

4.3 (24 reviews)

16 recommendations

zHealth

zHealth is an industry-leading, all-in-one chiropractic software with features - custom SOAP notes, integrated billing, scheduling & real-time phone support. The software comes with online appointment scheduling and unlimited rem...Read more about zHealth

4.6 (124 reviews)

11 recommendations

AdvancedMD Billing Services

AdvancedMD is a medical office software suite with cloud-based, integrated physician-patient workflow solutions including: practice management/medical billing, electronic health records, telemedicine, patient engagement, practice ...Read more about AdvancedMD Billing Services

4.1 (84 reviews)

11 recommendations

Nexus EHR

Nexus EHR is an ONC Certified 2015 Edition Cures Update cloud-based ambulatory EHR and PM platform. It is designed for small to midsize practices and various specialties including orthopedics, neurology, podiatry, cardiology, gene...Read more about Nexus EHR

4.6 (9 reviews)

11 recommendations

CollaborateMD

CollaborateMD is a medical billing and practice management solution that helps practices and billing services of all sizes automate and streamline billing and coding processes. The system was designed to be both comprehensive and ...Read more about CollaborateMD

4.2 (96 reviews)

9 recommendations

Azalea Health

Azalea provides cloud-based electronic health records (EHR), practice management (PM), revenue cycle management (RCM) and telehealth solutions for ambulatory and hospital care settings. Azalea is suitable for community and rural h...Read more about Azalea Health

4.3 (90 reviews)

9 recommendations

MDConnection

MDConnection is a web-based solution for medical practice management. The system serves the needs of small practices consisting of just one physician or a small group of physicians. The core functions include scheduling, medical b...Read more about MDConnection

4.6 (26 reviews)

9 recommendations

ModMed

ModMed, also known as Modernizing Medicine®, is an award-winning software company that places doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Services include electronic health...Read more about ModMed

4.2 (172 reviews)

8 recommendations

MedicsCloud EHR

Ideal for all levels of care, the MedicsCloud Suite operates as a singular solution from one vendor (ADS). Yet, the Suite's MedicsCloud EHR and its MedicsPremier financial/management segments are available separately as needed. ...Read more about MedicsCloud EHR

3.6 (11 reviews)

6 recommendations

Qualifacts Insync

Qualifacts InSync streamlines essential healthcare functions like charting, billing, scheduling, medication management, and telehealth within a cohesive cloud-based platform. Trusted by numerous practices nationwide, InSync elevat...Read more about Qualifacts Insync

4.5 (372 reviews)

5 recommendations

Buyers Guide

Last Updated: March 16, 2023

As of 2015, medical practices that treat patients with multiple chronic conditions through non-face-to-face visits (e.g., coordinating with other providers caring for the patient or verifying medication compliance with pharmacies) can qualify for reimbursement for those extra-in-person activities thanks to the Centers for Medicare and Medicaid Services Chronic Care Management (CCM) Program and the new billing code 99490.

Now, all the work you do outside of seeing your patients in-office to help treat their chronic conditions can be submitted and potentially covered, which is great news.

The bad news is that this program adds a whole new layer of Medicare billing, coding and tracking that practices have to deal with—and that extra burden is often too overwhelming for small practices.

Fortunately, practices using chronic care management software can more effectively manage Medicare reimbursements with a shift from fee-for-service billing to the CCM fee procedures.

Here's what we'll cover in this Buyer's Guide:

What Is Chronic Care Management Software?

Common Features of Chronic Care Management Software

Challenges of Chronic Care Management Software

Solutions and Benefits of Chronic Care Management Software

Tips for Selecting Chronic Care Management Software Features

What Is Chronic Care Management Software?

Chronic care management software integrates with and enhances existing electronic medical records (EMR) systems to add features that support CCM services. By connecting CCM software to your EHR, you'll be able to:

  • Identify patients who qualify for CCM care

  • Categorize them by their level of need

  • Record activities that qualify as CCM care

  • Create an audit trail by logging tasks as they're completed

  • Export data for billing and coding

  • Track patient histories over time to optimize treatment

The goal of this software is, simply stated, to make it easier for you to get reimbursed for the time you spend managing your patients' chronic conditions. With this software, you can provide better, more customized treatment to your patients while ensuring your valuable time never goes to waste.

In order for a patient to qualify for the CCM program, they must meet three criteria:

  1. The patient must be diagnosed with two or more chronic conditions, each of which are expected to last from one year to the patient's entire lifetime.

  2. The diagnosed chronic conditions must place the patient at risk of death, acute exacerbation/decompensation and/or functional decline.

  3. The patient's physician must establish, implement, revise and/or monitor a comprehensive care plan for the patient.

Once you recognize that a portion of your patients can be considered for the CCM program, you'll want to consider adopting chronic care management software to help you treat them.

Common Features of Chronic Care Management Software

A great way to gain a more in-depth understanding of what this software does is to learn about it's different features. While not all CCM systems will include the same functionality, here are a few of the key components you should expect to see when selecting the right software:

Patient consent/enrollment

Any forms or disclosure documents that alert the patient they qualify for the CCM program and obtain consent to receive CCM treatment.

Patient care planning

Creating a thorough care plan for each qualifying patient is a major component of CCM eligibility, and many software vendors include functionality to support development, implementation, tracking and modifications to these care plans.

Task/time logging

Another part of the CCM program is a time requirement. In order to bill Medicare, physicians must spend a certain amount of time each month on these non-face-to-face services.

Billing

Utilized logs, patient plans and other reports to streamline Medicare billing at the end of each month.

HIPAA compliance

In addition to the requirements for patients and their care plans, CCM software must meet specific HIPAA requirements in order to ensure patient privacy. Software vendors who do meet these requirements will be able to provide documentation proving their HIPAA compliance.

User dashboard

A live, real-time dashboard that shows your current CCM minutes and tasks.

Here's an example of patient care plan functionality in ThoroughCare's CCM product. Note that it enables users to track time spent working on the care plan down to the hundredth of a second (see the timer bar at the top of the screenshot), and offers the ability to log time directly from the care plan app.

Care-planning-in-ThoroughCare's-CCM-module

Care planning in ThoroughCare's CCM module

Keep reading for more information on selecting the right set of CCM software features for your small practice.

Challenges of Chronic Care Management Software

Before you jump into the world of chronic care management, though, there are a few potential issues worth noting.

Obtaining and maintaining the technology is your responsibility. There is currently no way to be reimbursed through Medicare for money spent on chronic care management software or any other software/hardware system designed to make CCM easier. The cost can be high depending on your chosen deployment method and payment plan, and there are HIPAA privacy requirements that CCM systems must follow.

Patients must be notified and consent to the CCM program. You cannot track and bill time spent working with chronic patients who have not given explicit consent to be included in the program, which means you must explain the system to qualifying patients and obtain written consent. This burden can be mitigated with chronic care management software, but it should still be a consideration if your patients might be reluctant to sign up.

It's time consuming. The billing process, while made simpler with CCM software, is complex. In order to submit hours for reimbursement, you'll need to collect a lot of information and be prepared to share detailed documentation for all of it.

Solutions and Benefits of Chronic Care Management Software

Now that we've covered some of the potential challenges of participating in the CCM program, it's worth considering some of the solutions to those challenges and other benefits provided by chronic care management software.

Increased revenue for practices. This one is a no-brainer. By taking advantage of billing code 99490, physicians will no longer lose revenue for the time they spend caring for chronic patients outside of face-to-face visits. At around $42 for every 20 minutes of non-face-to-face time, physicians stand to earn back a massive chunk of lost revenue. In fact, estimates back in when the new billing code because available in 2015 put the average annual revenue for CCM hours at $75,000. With the increased profit, you can expect high ROI after purchasing and maintaining chronic care management software.

Better treatment for chronic patients. Thanks to benefits like strictly outlined patient plans, designated communication channels, a streamlined referrals process and a reduction in face-to-face visits, patients suffering from multiple chronic conditions enjoy easier, more convenient care, which in turn results in an overall boost to both patient engagement and satisfaction. With features that handle patient notifications and consent for you, you and your patients are free to enjoy the benefits of clearer, more convenient communication channels.

Fewer hospital admissions. By providing more robust care for chronic patients outside of visits, physicians can actually reduce the number of times patients need to be admitted to the hospital for preventable complications, readmissions, or emergency care. That means less time spent at the hospital or filling out paperwork and more time spent actually treating your patients.

Tips for Selecting Chronic Care Management Software Features

When choosing the best chronic care management software for your practice, it's easy to get overwhelmed by all of your functionality options. Here are a few quick tips to help you select the most important features for your practice:

  • Thanks to the CCM Program's strict requirements, you automatically know which two features are absolute must-haves regardless of practice size or problem areas: care planning and time tracking. Doesn't matter what your specific needs are, these two features are the first things to look for when evaluating software products.

  • Another no-brainer to look for is HIPAA certification. While this isn't exactly a function of the software, it's absolutely imperative that you verify any potential vendor's certification status before moving forward with your research. If a product isn't HIPAA compliant, there's no point in learning more about it.

  • When it comes to participating in the CCM Program, billing is typically the biggest hassle. If your practice struggles to keep track of necessary information or submit claims on time, you need robust billing functionality that automates as much of those processes as possible.

  • If your biggest pain point is communicating with patients, explaining their chronic care options or collecting and keeping track of consent forms, you need software with messaging capabilities and an EHR integration. You should strongly consider products with patient portals and e-signature support to make staying in touch with your patients as easy as possible.

Remember, these tips are useful when working through your functionality options, but ultimately you are an expert in knowing what your practice needs. You're the one who runs it, spends every day in it and deals with its problems firsthand, and that makes you the most qualified person when it comes to identifying the feature solutions you need to invest in.