1. Private and Confidential
CHRONIC CARE
MANAGEMENT
CPT: 99490
Dennis Mihale, MD, MBA
Private and Confidential

2. PRIVATE & CONFIDENTIAL
A technology-enabled services platform for providers to offer a Chronic Care Management program to eligible Medicare patients.
PRIVATE & CONFIDENTIAL

3. Private & Confidential
Healthcare Today
This causes: increased health expenses, unengaged patients, fragmented health data, and poor health outcomes.
Private & Confidential

4. CMS Creates A Massive Market
Private & Confidential

5. Chronic Care Management (CCM)
Agenda:
Overview of CareSync
Chronic Care Management (CCM) Code
CCM Services and Technology Rules
How CareSync Works
How to Get Started
Questions

6. Overview of CareSync
CareSync is the leading patient-centered engagement solution that combines technology with 24/7 nursing services to facilitate care coordination among patients, family & caregivers, and all providers.
CareSync provides turnkey Chronic Care Management services and a software-only option, allowing practices of any size to easily meet the billing requirements for CPT code We began offering our CCM services 2 years before CMS announced the new code. CareSync’s certified technology makes it simple for providers to meet Meaningful Use 2 for Data Exchange, Messaging, and Timely Access.
CareSync patients are at the center of their healthcare, with access to health information, actionable goals, and Comprehensive Care Plan tasks, and as a result, are experiencing more productive medical appointments and better health outcomes.

7. Chronic Care Management
New for 2015! For the first time ever, CMS has started paying monthly reimbursements to providers who perform non face to face chronic care coordination services.
CPT Code: Pays approximately $46 (in CT) per month to providers who deliver 20+ minutes of non-face-to-face chronic care coordination to eligible Medicare beneficiaries.
Requirements While a great new opportunity, CPT Code comes with a set of strict technology and services requirements. The good news? You can outsource them, and reap the benefits of this great new program.

8. Dr. Dennis Mihale Introduction
Directly works with
CMS CCM team
FSCO/DSO (MAC) CCM team
Cover 12 southern states
Medicare Admin Contractor
Noridian (MAC in Northwest)
10 million lives
CMS Physician Champion for ICD-10 in Florida
Dennis and CareSync are front and center for CMS and for thousands of practices
Founded multiple technology healthcare companies
caresync
Private and Confidential

9. What is so Good About This New Code?
What’s In It For Me?
What is so Good About This New Code?
EVERYTHING

10. What’s In It For Me? Revenue, Respect and Recognition
Get paid for the services you provide
Be recognized and valued for your work
Do it before someone poaches your patient
A Complete Picture of My Patient (Finally!):
Other doctors, visits, labs, tests, medications
Things that happened between visits
Enlist the aid of family, friends and caregivers
Your Patient Values Your Work

11. What’s In It For My Practice?
Help other physicians taking care of my patient
Access to critical information including medications
Avoid duplicate tests
Medication reconciliation and treatment adherence
Much easier if you know what other docs are prescribing
Medications only help if your patient takes them
Meaningful Use Compliance
Core Measurements 7 and 17
These are the two tough ones
HEDIS Compliance
COPD, Colonoscopy and DM Management

12. What’s In It For My Patients?
Benefits to Patient & Family
Patient Centric Care
Access - Understanding - Use
Fewer ER visits and Admissions
Improved Self Management
Administrative Services delivered at home: patient avoids travel
Clinical visit focuses on patient care, treatment and improvement
Ability for patient and family to participate in care
All patient information in one secure place
Improved outcomes and patient satisfaction  helps with STARS
24/7 Access to Healthcare Assistants (CareSync)

13. Chronic Care Management Billing Protocols
24/7 patient access to clinical staff to address urgent chronic care needs
Continuity of care through access to established care team for success routine appointments
Ongoing care management for all chronic conditions, including medication reconciliation and a regular patient assessment
A comprehensive, patient-centered health summary and care plan that includes all patient records from all providers
Private and Confidential

14. Chronic Care Management Billing Protocols
Management of care transitions between and among all providers and settings using the electronic transmission of information
Coordination with home and community based clinical service providers
Patient and caregiver access, with opportunities for all relevant caregivers to communicate about the patient’s care
Private and Confidential

15. Eligible Patients & Chronic Conditions
Medicare beneficiaries with two or more chronic conditions These are conditions that are expected to last at least 12 months, or until the death of the patient. They must put the patient at significant clinical risk: acute exacerbation, worsening of symptoms and/or death
What conditions count? CMS maintains a Chronic Condition Warehouse with 22 chronic conditions listed, however, it is not an exclusive list. Website:

16. Eligible Providers Physicians (regardless of specialty)
Advanced Practice Registered Nurses
Physician Assistants
Clinical Nurse Specialists
Certified Nurse Midwives
Non-physician practitioners and limited-license practitioners such as social workers and clinical psychologists, are not eligible to bill for CCM

17. When You Cannot Bill CCM
When your patient is in the hospital (inpatient)
When the patient is in a Skilled Nursing Facility
When the patient is in a Nursing Home
When the patient is under Hospice care supervision
When Transitional Care Management services are billed
The rationale for these exclusions is that the services provided significantly overlap with care management activities that are included in the facility payments.

18. Patient Consent
You must obtain the patient’s written consent, confirming that the following has been explained to the beneficiary:
An overview of Chronic Care Management
How the CCM service may be accessed
That only one provider can perform CCM services at a time
That information will be shared among all of the patient’s providers
That the patient may terminate the CCM service at any point in time by revoking consent
That the patient will be responsible for any associated copayment or deductibles. For those without a supplemental plan, it’s roughly $9.
Once consent has been obtained, a copy must be stored in the patient’s medical record. If a patient revokes consent, you may not bill for CCM after the month the revocation was made. If 20+ minutes has already been completed, you may bill for that month.

19. The Comprehensive Care Plan
The patient-centric Care Plan: The spirit of 99490
Should include all of the patient’s healthcare providers, family & caregivers, all health conditions, and must be aligned with the patient’s choices and values.
CMS recommends:
Comprehensive problem list
Symptom management and planned interventions
Accessible community and social services
Plan for care coordination among all providers
Medication management and adherence tracking
Designated person responsible for each intervention
Requirements for regular review/revision

20. The Comprehensive Care Plan: Technology
The Care Plan must be created using some form of electronic technology, but CMS recognizes that current EHR technology is limited in its scope to support electronic care plans.
Three Requirements:
All “care team members” must have 24/7 electronic access
The billing provider “must electronically share care plan information as appropriate with other providers” who are delivering care to the patient (no fax allowed).
The billing provider must provide a paper or electronic copy of the care plan to the patient.

21. Technology Requirements They do not make it easy, do they?
You must use Certified EHR technology
For 2015, this includes any EHR that has met the 2011 or criteria of the EHR Incentive Program.
You must generate a patient-centric Care Plan with records from all providers and all disease states
You must make the Care Plan available to the patient and all other providers.
They do not make it easy, do they?
Can do more here. Just wanted to get some stuff down.

22. Additional Requirements
24/7 access to the care team
To address urgent chronic care needs
Facilitate care coordination
An answering service does not meet this requirement
Transitional Care Management
You must facilitate all transitions of care
You may not bill for CCM during the same month as TCM
Care Coordination
You must have the ability to coordinate care with home and community based providers, including home health, nutrition services, outpatient therapies, and transportation services, to name a few. Communication must be documented

23. CareSync and Chronic Care Management
CareSync’s CCM solution has the perfect fit for practices of all sizes.
Complete Chronic Care Management
CareSync technology + turnkey CCM services
We provide the service every month, you bill
Software as a Service (SaaS)
Use of the CareSync web, iOS, and Android technology
You meet CMS’ requirements for services provided and use CareSync to bridge any gaps in your existing technology
Private and Confidential

28. Examples of CCM Activities
Getting all patient records from all providers
Creating the patient centric comprehensive care plan
Scheduling appointments with any provider
Helping patient fill out insurance forms
Speaking to patient about their medications and overseeing patient self-management of medications
Taking calls on evenings and weekends
Reconciling medications
Ensuring receipt of all preventive services
Monitoring patient conditions—Physical, mental and social

29. What Revenue Is In It For Me?
Revenue varies by Medicare Region
It is approximately $46 per member per month
For 100 members enrolled in CCM  $24,000 per year*
For 1,000 members enrolled in CCM  $240,000 per year*
There are costs associated with deploying this solution
Staff to provide the service, unless you have people sitting around doing nothing. Yeah – like that ever happens.
Costs to meet technology requirements
(* Approximate revenue net of CareSync’s full service fees)

30. CCM: Benefitting Providers and their Patients
Comprehensive picture of a patient’s health
Complete medication reconciliation and adherence
Healthier, happier patients
Generating new, recurring revenue
Patients
All health information in one secure place
Personalized Care Plan with actionable goals and tasks
Improved health outcomes and satisfaction
Family & caregiver access like never before
24/7 access to Health Assistants
Private and Confidential

31. Getting Started is Easy
We’re ready to get you started today!
No burden to you or your staff
No disruption to existing workflows
No cost to you
Implementation takes a few hours, not days, weeks or months!
CareSync is designed to work with your existing technology
Trained Care Coordinators are equipped with proven tools to onboard your eligible patients
Private and Confidential

32. Private and Confidential
Welcome Kits
Private and Confidential

33. Private and Confidential
Resources and contact information
For more information, view our resource page
Contact: Rosemary P. Hokanson Physician Network Education Manager
Phone:
caresync
Private and Confidential

34. Private and Confidential
CHRONIC CARE
MANAGEMENT
CPT: 99490
Dennis Mihale, MD, MBA
Private and Confidential

35. Private and Confidential
APPENDIX
caresync
Private and Confidential

36. How can they do it for Only $9.20? It’s CareSync Magic
APPENDIX A: The Co-Pay
Only if no supplemental and no Medicaid
CMS values this at $46 per month
They are asking you to only pay $9.20 a month
What are you getting for this $9.20?
24/7 access, even when it is not urgent
Your Family Physician knows what is happening with all other providers just by you signing up
No matter where you are in USA, doctors can access all your medical information with your permission
Help you take your medications on time
Help you with insurance forms and surveys
Answer questions about your insurance
Remind you about doctor visits, labs and tests
How can they do it for Only $9.20? It’s CareSync Magic
caresync
Private and Confidential