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Chronic Care Management CPT Code 99490: Increase Patient Care Quality and Take Advantage of a $27 Billion Dollar Market Opportunity for Physicians

In 2015, when CMS began the Chronic Care Management Program, CPT Code 99490, according to Medicare claims data, only about 275,000 unique Medicare beneficiaries received Chronic Care Management (CCM) services (CPT Code 99490) an average of 3 times each, totaling $37 million in allowable charges.  Unfortunately, those early participants accounted for less than ~1% of those Medicare beneficiaries that actually were potentially qualified to participate in the CCM Program. So, ~99% of the beneficiary market was still potentially avai...

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Population Health Management: The Next Step to Deliver Impact

  The population health management (PHM) industry is still in its adolescence, but further evolution is necessary and inevitable to take care delivery to the next level. By now, most have a sense of the value PHM can add and understand the macro steps needed for a successful population health initiative. The industry is good at identifying the sick in our populations and even predicting who will be sick in the future. The market is also good at developing guidelines and treatment plans to help manage chronic disease. Where the i...

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Healthcare 2017 - What Can We Expect In The Year Ahead?

According to Heraclitus, a Greek philosopher, “change is the only constant in life”. While 2017 hardly represents a lifetime, this will be a year of profound change in healthcare. Look all around, the winds of change are blowing. We have surveyed the landscape and here a few of the topics and observations that captured our attention. The Healthcare Law of the Land – Accountable Care Act (ACA) or Obamacare, whatever your preferred name for the current healthcare law, there will be change. In a recent report, NPR noted that t...

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Care Coordination Services Deliver Impressive Cost Saving Results

On the road to value-based care, providers, payers, the self-insured and other risk-bearing entities invest in care coordination programs to improve patient or member care. The good news is that often times, the care coordination programs supported by a robust technology platform utilizes predictive modeling algorithms to identify risk profiles for program participants and track and report patient/members interactions that are implemented by skilled care managers. The bad news, and what is more problematic, is that it can be difficult to quanti...

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2016 Updates to Chronic Care Management CPT Code 99490

2016 Updates to Chronic Care Management CPT Code 99490

FQHCs and RHCs Are Now Able to Bill for CCM Services When CMS introduced the opportunity for providers to bill for CPT code 99490 in January 2015, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were excluded from participating. However, beginning January 2016, FQHCs and RHCs may now participate in the program and receive an additional payment from CMS for the costs of services that are not already captured in the RHC all inclusive rate or the FQHC prospective payment system for chronic care management services to ...

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HIMSS 2016 Round-Up

HIMSS 2016 Round-Up

HIMSS 2016 was a whirlwind of activity, from the opening session to the closing remarks. Not surprisingly, Las Vegas as the host city only added to the usual excitement. With conference activities sprinkled among five levels in the Sands Expo Center, the show was a little tricky to navigate; on more than one occasion what seemed like a brief walk between venues took much more time than expected. But, the real highlights were associated with the hot topics at the show. We’ll highlight three in this blog. Population Health Management...

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5 Healthcare Trends for 2016 Affecting Value-Based Care and Population Health Management

5 Healthcare Trends for 2016 Affecting Value-Based Care and Population Health Management

New healthcare trends in 2016 and in years down the road will affect value-based care and population health management. The healthcare industry continues to evolve, and comes with both good and bad news regarding healthcare costs. A reminder, healthcare costs as a percent of Gross Domestic Product have hovered around 17.5 percent for the last few years. The bad news: costs as a percentage of GDP are projected to increase and reach 19.6 percent by 2024. Conversely, the good news is that the growth in healthcare costs are not due to simple inflat...

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Tips from a Care Coordinator: Navigating Chronic Conditions Through the Holidays

Tips from a Care Coordinator: Navigating Chronic Conditions Through the Holidays

Whether you are a care coordinator, caregiver or a family member of someone who is getting up in age, chances are you know someone with chronic conditions. During the holidays, many factors affect the people around us, especially those with chronic health conditions. Whether it's the holiday blues, traveling out of town or trying to manage diet restrictions and other self-care measures, these are all things that need to be monitored with extra care over the holidays. Here are some tips on navigating chronic conditions during the holiday season....

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Why Chronic Care Management is the Future of Health Care [Infographic]

Why Chronic Care Management is the Future of Health Care [Infographic]

In 2012, about half of all Americans suffered from some sort of chronic disease, such as diabetes, heart disease, or lung disease. In addition to this excessive amount of people suffering, the health care system is suffering as well. $3 out of $4 in health care are spent on chronic disease. Reducing and better managing chronic diseases has the potential to improve the lifestyle of millions of adults in the US while also cutting costs for healthcare providers.  In recent years, the growing epidemic of chronic disease in America has not g...

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4 Ways to Increase ROI With Chronic Care Management & CPT Code 99490

4 Ways to Increase ROI With Chronic Care Management & CPT Code 99490

Today, approximately 117 million people - about half of all adults - suffer from one or more chronic health condition and one in four adults have two or more chronic health conditions, such as asthma, diabetes and congestive heart failure. Although these are some of the most common illnesses among the population today, they are becoming more and more manageable due to preventative measures taken by both physicians and healthcare entities as well as patients. With the introduction of CPT code 99490 on January 1, 2015, CMS began reimbursing fo...

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