Increase profit $200K+ annually with CCM & RPM

Are you a small fish trying to get into a bigger bowl? If your revenues aren't quite what you want them to be, this is how small practices can quickly become large, and large practices can become powerhouses.

Boosting RCM Revenues While Providing Better Patient Care

Both large and small practices benefit from performing additional services for patients that increase the bottom line. These benefits also extend to the patient, who receives better care and management of health conditions than would normally be given by their physician. Two programs that support this very well are Chronic Care Management (CCM) and Remote Patient Monitoring (RPM). Both are easily billable for practices on Elation Billing. These programs not only keep practices financially solvent (particularly new practices), but also open the door to exponential growth.

Chronic Care Management

For a patient to be eligible to receive Chronic Care Management Services, they must have multiple (2 or more) chronic conditions expected to last at least 12 months or until the patient’s death and or that place them at significant risk of death, acute exacerbation and or decompensation, or functional decline. 

‍

Examples of chronic conditions include, but are not limited to:

‍

• Alzheimer's disease and related dementia
• Arthritis (osteoarthritis and rheumatoid)
• Asthma
• Atrial fibrillation
• Autism spectrum disorders
• Cancer
• Cardiovascular disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Depression
• Diabetes
• Hypertension
• Infectious diseases like HIV and AIDS

‍

If the patient qualifies for these services and is interested in enrolling, the provider must create a comprehensive care plan in the EHR, while also thoroughly documenting the patient’s medical history. The care plan is shared with the patient along with any person involved in the patient’s care (caregivers, family members, other providers, etc.). Notably, only one provider can furnish and bill for these services during a calendar month. The patient has the option to switch providers at any time. Providers eligible to deliver these services include Physicians, Certified Nurse Midwives, Clinical Nurse Specialists, Nurse Practitioners, and Physician Assistants.

‍

Plan Example

‍

Chronic Care Management Coding

‍

• CPT code 99490 - non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability
• CPT code 99439 - each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified healthcare professional (billed with CPT code 99490) 
• CPT code 99484 - Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional per calendar month
• CPT code - 99487 complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate- to high-complexity medical decision making 
• CPT code 99489 is each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified healthcare professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490) 
• CPT code 99491 - CCM services provided personally by a physician or other qualified healthcare professional for at least 30 minutes

‍

Chronic Care Management Reimbursement

‍

Remote Patient Monitoring

Remote Patient Monitoring (RPM) is a type of telehealth in which healthcare providers monitor patients outside the traditional care setting using digital medical devices, such as weight scales, blood pressure monitors, pulse oximeters, and blood glucose meters. The data collected from these devices are then electronically transferred to providers for care management. Automated feedback and workflows can be built into data collection, and out-of-range values or concerning readings can be flagged so the patient can be quickly contacted for emergency care. 

‍

Patients with the following conditions are prime candidates for RPM:

‍

• Hypotension
• Hypertension
• Prediabetes
• Type 1 Diabetes
• Type 2 Diabetes
• Congestive Heart Failure (CHF)
• Chronic Kidney Disease (CKD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Obesity
• Atrial Fibrillation
• Asthma

‍

How It Works

‍

The practice identifies patients with the above conditions with eligible insurance to cover treatment (normally Medicare or Medicare Advantage plans). If the patient agrees to participate in this treatment, they will have a free monitoring device shipped to them along with instructions on how to use it. The patient will also have ongoing 24/7/365 support from medical professionals.  

‍

Common Devices Used

‍

Remote Patient Monitoring Coding

‍

CPT code 99453 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. 

CPT code 99454 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supplied with daily recording(s) or programmed alert(s) transmission, each 30 days. 

CPT code 99457 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. 

CPT code 99458 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes. 

CPT code 99091 - Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days. 

‍

Remote Patient Monitoring Reimbursement

‍

Case Study

• ARR Pace - $214,464
• The above is in ADDITION to the practices monthly revenues, giving the practice a nice bump each month

‍

This family practice more than doubled gross revenues from May to June, which is when billing for CCM and RPM began. There is a slight dropoff in July, but a quick rebound in August as the program stabilizes. It is worth noting that this increase happened without adding any additional providers or staff to the practice. How is this possible? 

‍

Outsourcing RPM and CCM Services

‍

By working with an outsourced company specializing in these services, an Elation Billing practice gets all of the support without any of the overhead. Our current partner is NSight Health. When a practice makes the decision to proceed with the CCM and/or RPM programs, a list of potentially eligible patients can be generated in Elation Billing (mostly based on insurances that pay for these services). The Elation EHR also has a feature to determine eligible patients based on diagnoses codes, so that process can narrow things down even further. Once the list is confirmed, NSight will -

• Reach out to all identified patients
• Get consent for participation
• Send out RPM devices
• Provide ongoing patient support. This includes scheduling appointments, patient education, and promoting medication adherence
• Contact the patient a minimum of once a month
• Monitor for abnormal results, check on the patient as necessary, and inform the provider
• Document in the EHR all patient interaction
• Generate the billing codes each month for claim submission
• Provide services to English and Spanish speaking patients

‍

NSight operates as an extension of the practice. The cost is 60-70% percent of the CCM/RPM revenues, giving the provider 30-40% profits with very little work involved. As further incentive, NSight does not collect on any unpaid claims. If the doctor doesn’t get paid, they don’t get paid. Elation Health should be able to negotiate for very favorable terms as part of scaling the RCM division.

‍

‍