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:

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

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