Chronic Care Management (CCM) Reimbursement and Compliance Updates

Event Materials (Key Required)

Course Description

CMS began payment for Chronic Care Management in 2014, with multiple changes throughout the past 9 years (adding more codes, adding a New concept – Principle Care Management, increasing fees by 50%). CCM has become a hugely profitable endeavor for many healthcare providers.

More vendors are coming to the “playground” with their software, clinical teams, and billing capabilities. Providers must be more vigilant in choosing CCM vendors because the billing is always done under providers making them accountable for everything the vendor is doing. Understanding compliance, knowing best practices, and starting off appropriately is essential for a Chronic Care Management program to be effective, compliant, and efficient.

Learning Objectives

• To verbalize key component of CCM
• To summarize evaluation plan
• To identify what is needed for the Implementation Plan
• Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements
• Examine the Scope of Services required to bill Medicare for CCM services
• Identify how CCM can close care gaps and engage patients
• Assess the financial and quality implications of incorporating CCM in your practice
• Recognize the importance of CCM in relation to quadruple aim

Areas Covered in the Session

• Sobering Statistics
• History of CCM
• What is Chronic Care Management
• CCM Activities
• Patients Eligibility
• Examples of Chronic Conditions
• Provider Responsibility
• Face-to- Face Visits ( within 12 month)
• Consent
• Establishing, Revising and Providing pt with a Comprehensive Care Plan
• Designated care team member
• Certified EHR
• 24/7 coverage
• Initiating Visit
• Consent
• Comprehensive Care Plan
• Billing
• Who can bill for CCM?
• Physicians and Non-Physician Practitioners (NPP)
• Certified Nurse Midwives
• Clinical Nurse Specialist
• Nurse Practitioners
• Physician Assistants
• RHC and FQHC
• Hospitals & Critical Access Hospitals
• Who can not bill for CCM?
• Clinical psychologists
• Podiatrists
• Dentists
• Who can provide CCM 
• Clinical Staff
• CPT Definition
• CMS  Definition
• Know the Rules
• Transitional Care Management (CPT 99495 and 99496)
• Home Healthcare Supervision (HCPCS G0181)
• Hospice Care Supervision (HCPCS G0182)
• Certain End-Stage Renal Disease (ESRD) services (CPT 90951- 90970)
• Bonus Codes for Specialists
• Principal Care Management (PCM)
• Reimbursement Opportunities
• Benefits of Implementing CCM
• Case Manager Case Load
• Pros and Cons of Outsourcing CCM  
• Tips for outsourcing success
• CCM Platforms Overview
• What to look for in the software
• Pros and Cons of Using EMR for CCM  
• Best Practice
• FAQs

Suggested Attendees

• Nurses
• Doctors
• Nurse Practitioner
• Population Health Officers
• Innovation officers
• CNO/ CMO
• Billers
• Physicians
• PCP (MD, NP, PA)
• Specialists (MD, NP, PA)
• Nurse Managers
• C-Suite Healthcare Executives 

About the Presenter

Dr. Irina Koyfman, DNP, NP-C, RN, is a Nurse Practitioner and a Doctor of Nursing Practice with 25 years of nursing and 15 years of executive experience. Dr. Koyfman is an expert in the Patient-Centered Medical Home (PCMH), Home Health, Healthcare Start-ups, Transitional Care, Community Health, Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Care Coordination. Dr. Koyfman is a dedicated and enthusiastic clinician with an entrepreneurial drive. She has a history of establishing 4 successful healthcare ventures, where she drove significant operational growth (up to1,000%), built successful teams with high retention rates, and improved patient satisfaction and patient outcomes. She is a Subject Matter Expert in CCM and RPM, making her a frequent presenter at multiple conferences. As a founder of Affinity Expert, a healthcare consulting company, she has been consulting primary care providers on all aspects of CCM and its successful clinical, operational, and financial implementation. She has created a growing community of clinicians through her CCM/RPM groups on Facebook and LinkedIn where she provides free information and education to providers. She loves to give back and volunteers on multiple boards along with hands on volunteer work. 

Additional Information

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

Purchase Order Form - Click Here to download PO form. 

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