Better care should equal better reimbursements.
Chronic Care Management
Chronic care management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM services are critical components of primary care that promote better health and reduce overall health care costs.
Remote Patient Monitoring
Remote Patient Monitoring, also known as remote physiologic monitoring (RPM), is the use of technologies to gather biometrics like blood pressure, weight, oxygen saturation, pulse, and blood sugar levels. That information is electronically transferred to your care team.
As needed, you will be able to recommend early interventions instead of always reacting to crashes. RPM allows for objective data to supplement your understanding, and allow for the patient’s best care.
Behavioral Health Integration
Behavior Health Integration (BHI) is a type of care management service aimed at improving outcomes for patients with mental or behavioral health conditions.
CMS updated the Medicare Physician Fee Schedule (MPFS) policies to improve payment for care management services. New codes exist to differentiate between face to face visits and non face to face visits and the type of frequency of the visits.
Primary Care Management
Primary Care Management (PCM) is a stop gap used for patients that don’t have multiple chronic conditions, but do have a single chronic condition that could be greatly benefited by focused attention.
The diagnosis of a single chronic condition that is expected to last between 3 months to a year, or even until the death of the patient, potentially caused a recent hospitalization, or increases the risk of acute exacerbation/decompensation, functional decline, or death.
The codes in PCM differentiate between physician or qualified health professional time and other clinic staff time.
Remote Therapeutic Monitoring
Remote Therapeutic Monitoring (RTM) is similar to RPM but differs in several distinct ways. RTM is used to monitor non-physiologic data.
Although not exclusive, it includes health conditions such as musculoskeletal system status, respiratory system status, therapy adherence, and therapy response.
It is broad in its definition. Data can be self reported or transmitted digitally.
Transitional Care Management
Transitional Care Management (TCM) is a medicare program designed to help patients successfully transition back to a community setting after a stay in certain facility types. The care provided is interactive and informative giving the patient the greatest chance at a successful transition home.
There is a 30 day window for this care that begins the day of discharge and continues for the 29 days following. The care team must reach out within two business days to begin the care.
Download the Transitional Care Management Services Fact Sheet (PDF) fromCMS.gov
Patient Self Management
Even if you don’t get reimbursed for patient self care support, our software offers the guidance your patients need.
Self-management support is the help given to people with chronic conditions that enables them to manage their health on a day-to-day basis. Self-management support can help and inspire people to learn more about their conditions and to take an active role in their health care. *
* AHRQ’s Prevention and Chronic Care Program has developed a library of resources and videos that aims to help clinicians learn more about this concept. Please visit the Self-Management Support Library to access these resources.