Chronic Care Management (CCM) Services
Discover Effective Medicare Chronic Care Management Services for USA Physicians. We offer a complete turnkey-solution , Implementation, technology, patient engagement and care coordination
Transformative Chronic Care Management: Superior Solutions for USA Doctors
Chronic care management can be challenging for physicians, as it involves high patient volumes, care coordination, and administrative burdens. Engaging patients and navigating financial constraints further complicate the process.
At Vital Health Services, we offer Best solutions to streamline your Chronic Care Management. Our comprehensive program enhances care coordination, reduces documentation burdens, and improves patient engagement. Let us help you focus on what matters most—providing quality care to your patients.
Why Choose Vital Health Services among Other Chronic Care Management Companies?
Vital Health Services offers an extremely high-performing CCM chronic care management program that analyzes your population and helps create a registry of patients with two or more chronic conditions.
We enroll patients in the CCM Program and start managing their chronic conditions by engaging with them every month.
Our cutting-edge application creates automated and personalized care plans for each patient that enlist health problems and goals, other providers’ information, medications, and other information about the patient’s health. It also explains the care patients need and how it will be coordinated.
Top Chronic Care Management Service Company: Maximizing Patient Outcomes and Revenue
The leading choice for single or multispecialty groups, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs), and anyone prioritizing preventive care, Vital Health Service is your partner in delivering comprehensive healthcare solutions.
Comprehensive Turnkey Solution
✅ Implementation: We provide seamless integration of our solutions into your existing workflow, ensuring minimal disruption and maximum efficiency.
✅ Technology: Our state-of-the-art technology enhances every aspect of patient care, from scheduling and pre-screening to creating personalized care plans and managing chronic conditions.
✅ Patient Engagement: We prioritize patient engagement by maintaining regular communication and providing educational resources. This ensures patients are active participants in their healthcare journey.
✅ Care Coordination: Our team of skilled professionals coordinates all aspects of patient care, ensuring that all healthcare providers are on the same page and that patients receive the care they need when they need it.
Drive ACO Success with Vital Health Service
Vital health Services offers a fresh and innovative approach to Accountable Care Organizations (ACOs). Whether you are a new ACO or an experienced one moving towards full risk, our Care Coordination Program positions you for success through our comprehensive care coordination solutions, led by in-house population health experts.
Key Benefits
- Comprehensive Care Coordination: Our program provides thorough care coordination, ensuring that all aspects of patient care are managed effectively and efficiently.
- Expert Leadership: Led by our in-house population health experts, we bring a high level of expertise to our care coordination solutions.
- Innovative Attribution Strategies: We employ cutting-edge strategies to improve patient attribution, enhancing the accuracy and efficiency of care delivery.
- Improved Quality Scores: Our approach results in 10-15% higher quality scores, demonstrating significant improvements in patient care and outcomes.
- Risk Status and Disease-Specific Groups: We stratify patients based on risk status and specific diseases, allowing for targeted and effective care management.
Vital Health Service is dedicated to driving the success of ACOs by providing next-level care coordination and innovative strategies tailored to your organization’s needs.
Seamless Implementation
Innovative Chronic Care Management Platform: Dedicated Care Coordinator and Seamless Implementation
Have multiple locations? Multiple fee schedules? Multiple EHRs? No problem! Vital Health Services runs the largest, most complex CCM implementations in the industry. Our team comes from some of the leading consulting firms.and have established robust work streams to ensure a smooth and successful launch. And are supported by a team
- Dedicated Implementation Manager
- Dedicated Care Coordinator
- Dedicated quality program manager
Helping Patients Overcome Social Barriers
Vital Health Services is pioneering a comprehensive approach to care coordination that goes beyond the patient’s clinical needs to address the social determinants of health, including social barriers in healthcare.(Social needs)
These social determinants play a crucial role in overall well-being and health outcomes. Vital Health Services aims to provide holistic care that improves overall health and quality of life by considering factors such as housing, food security, education, and economic stability.
Social Assessments
Social Assessments
Vital Health Services captures “social data“ from the purest source—directly from the patient. Captured through a series of proprietary social assessments, the data is used to identify social barriers and inform interventions. Common assessments include housing & environmental risk evaluations, food insecurity analysis, transportation barriers identification, and family support analysis. Ultimately, the social assessments are designed to uncover hidden risk.
Overcoming the Social Determinants of Health
Leveraging data from proprietary patient assessments, our analytics engine identifies the patient’s “social risk.” With the aid of community-based organizations, Vital Health Service’s clinical teams implement targeted interventions to knock down social barriers, resulting in a reduction of avoidable admissions or readmission, improved compliance, and overall healthier and happier patients.
Chronic Care Management Template
A Chronic Care Management Template simplifies how you manage patient care. With a clear structure, you can easily track appointments, monitor treatment plans, and schedule follow-ups.
This organization saves you time and reduces the chances of errors or missed visits. By cutting down on paperwork and confusion, you can focus on what matters: delivering high-quality care to your patients. Using a CCM template can transform your practice into a more efficient and effective healthcare provider.
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FAQs
What is CCM ?
Chronic Care Management (CCM) is a Medicare program that provides reimbursement to healthcare providers for coordinating care for Medicare beneficiaries with two or more chronic conditions. The goal of CCM is to improve patient outcomes, reduce hospitalizations, and enhance care coordination between providers
What is the meaning of chronic care management?
Chronic Care Management (CCM) refers to a coordinated healthcare strategy designed for patients with two or more chronic conditions expected to last at least 12 months. It focuses on improving health outcomes, enhancing quality of life, and reducing healthcare costs through comprehensive care and support.
What is PCM in Medical?
Principal Care Management (PCM) in the medical context refers to a specialized approach for managing patients with a single high-risk chronic condition. This model is designed to provide focused care coordination and treatment for individuals whose conditions require ongoing monitoring and frequent adjustments to their care plans.
What is the difference between CCM and PCM?
Chronic Care Management (CCM) and Principal Care Management (PCM) are both healthcare services aimed at supporting patients with chronic conditions, but they differ in focus. CCM is designed for patients with two or more chronic conditions expected to last at least 12 months, emphasizing comprehensive care coordination and management strategies to improve health outcomes. In contrast, PCM targets patients with a single chronic condition requiring intensive management, focusing on that one high-risk diagnosis. Both services involve care coordination and billing under specific Medicare codes, but they cater to different patient needs within the healthcare system.
What does C C M stand for?
CCM stands for Chronic Care Management. This is a structured approach designed to coordinate care for patients with two or more chronic conditions that are expected to last at least 12 months or until the patient’s death. The primary goals of CCM are to improve patient outcomes, enhance the quality of care, and reduce hospitalizations by providing comprehensive care coordination.
How Much Medicare provides separate reimbursement under the Physician Fee Schedule for non-face-to-face chronic care management (CCM) services?
Medicare provides significant reimbursement for non-face-to-face chronic care management, with codes ranging from $62-$92 per month. Proper utilization of these codes can generate additional revenue for practices while improving care coordination and outcomes for patients with multiple chronic conditions.
CPT code 99490
CPT code 99490 is used to bill for Chronic Care Management (CCM) services provided by clinical staff under the direction of a physician or other qualified healthcare professional. Here are the key details about CPT 99490:
Requirements
- At least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month
- Establishment, implementation, revision, or monitoring of a comprehensive care plan
- Coordination of care with other providers and agencies
- Medication management
- Patient education and self-management support
Reimbursement
- The national average Medicare reimbursement rate for CPT 99490 in 2023 is $62.69 per patient per month
- Actual reimbursement varies by geographic region and may be higher for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Billing Guidelines
- Can only be billed once per patient per calendar month
- Cannot be billed in the same month as certain other care management codes like Transitional Care Management (99495-99496) or Home Health Care Supervision (G0181)
- Requires an initiating visit with the billing provider within the prior 12 months
- The patient must provide verbal or written consent to receive CCM services
Eligible Providers
- Physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical nurse specialists
- Must be legally authorized to provide CCM services in their state
What is the difference between 99487 and 99490?
The difference between CPT codes 99487 and 99490 lies primarily in the complexity of care, the duration of service, and the level of medical decision-making involved.
CPT Code 99487
- Purpose: This code is designated for complex chronic care management (CCM).
- Time Requirement: 60 minutes of clinical staff time directed by a physician or qualified healthcare professional (QHP) in a calendar month is required.
- Complexity: It is used for patients with two or more chronic conditions that necessitate moderate to high complexity medical decision-making. This typically involves substantial revisions to the comprehensive care plan due to the complexity of the patient’s condition
- Reimbursement: The reimbursement rate for this code is generally higher, around $134.27 per month
CPT Code 99490
- Purpose: This code is used for non-complex chronic care management.
- Time Requirement: It requires only 20 minutes of clinical staff time per month under the direction of a physician or QHP.
- Complexity: It applies to patients with two or more chronic conditions expected to last at least 12 months, but these conditions do not require the same level of decision-making complexity as those billed under 99487
- Reimbursement: The reimbursement for this code is lower, averaging about $64.02 per month
What are Chronic Care Management (CCM) CPT codes?
- CPT 99490: Non-complex CCM, at least 20 minutes of clinical staff time per calendar month.
- Reimbursement: Approximately $62.69
- CPT 99439: Each additional 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (add-on to 99490).
- Reimbursement: Approximately $48
- CPT 99491: CCM services provided personally by a physician or other qualified healthcare professional, at least 30 minutes per calendar month.
- Reimbursement: Approximately $86
- CPT 99437: Each additional 30 minutes of physician or other qualified healthcare professional time, per calendar month (add-on to 99491).
- Reimbursement: Approximately $61
- CPT 99487: Complex CCM, first 60 minutes of clinical staff time per calendar month.
- Reimbursement: Approximately $92.65
- CPT 99489: Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (add-on to 99487).
- Reimbursement: Approximately $46.32
How can a CCM program benefit my healthcare organization?
Whether you’re a primary care office or a specialty provider, our Vital Health Services care team is here to support you in closing gaps in patient care. Addressing these gaps helps improve your MIPS scores, Star Ratings, and ACO compliance, which can lead to better reimbursements. Additionally, your practice can create a steady revenue stream by billing for Chronic Care Management services, using CPT codes 99490 or G0511
How does a CCM program benefit my patients?
Medicare patients with multiple chronic conditions are at high risk for serious health issues. With Chronic Care Management (CCM), you can offer these patients around-the-clock support and personalized care plans. By integrating CCM with the care you already provide, you can help lower their chances of emergency room visits and enhance their overall quality of life.
Why should I consider outsourcing my Chronic Care Management solution?
Healthcare providers can offer Chronic Care Management (CCM) independently, but it is more operationally complex than one might anticipate. The technology and resources needed to deliver a comprehensive and compliant service are extensive but essential. Outsourcing can provide access to these resources along with a dedicated care team available 24/7 to support your program.
Why is Vital Health Services one of the Best Chronic Care Management (CCM) Companies? How Does Our Program Works?
Our team identifies CCM-eligible patients from your practice’s EMR and contacts them to obtain their consent to participate in the program. After enrollment, we communicate with the patients every month to engage in care coordination activities aimed at improving their health outcomes. Additionally, we provide them access to our 24/7 nurse line. All activities are documented in a comprehensive care plan, which is then shared with the provider through the EMR.
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