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Automating documentation and billing makes chronic care management more achievable

When the Centers for Medicare and Medicaid Services (CMS) introduced its Chronic Care Management (CCM) program in 2015, its main goal was to begin aligning financial incentives with evidence-based best practices.

CMS recognizes that care management for patients with chronic conditions is an integral contributor to reducing the devastating health effects those conditions have on patients and populations. They also recognized it is a key to reducing the exploding cost of caring for those patients.

Investing roughly $42 per month per member on just 20 minutes of CCM for patients with two or more chronic conditions can save millions or even billions down the road. It also answers the perennial question “Who’s going to pay for all of this?”

Despite these benefits, however, participation in the CCM program by primary care physicians has been underwhelming. Why aren’t more physician offices taking advantage of it? For some, it is still matter of education about the program. For many it has been the difficulty of documenting the care or understanding the program in general – after all this is still a government program – which adds yet another administrative burden. Some also fear penalties from CMS if they get the complex documentation wrong. For others, it is a lack of time and resources to set up the necessary structure to do it properly.

There is good news on that front for those using the Aprima electronic health record (EHR) system, however. We have just introduced new functionality that helps automate the process of documentation and billing for CCM services. You can read more about it here.

Rather than going back through records manually at the end of the month to add up the amount of time spent on follow-up care (such as phone calls to ensure patients close care gaps or are taking their medications), that time is documented automatically during the activity. Whether the time is spent all at once, or in many small slices throughout the month, it’s all tracked in one place. Physician offices can then view the running total to ensure it meets the 20 minutes per month minimum required by CMS.

If they are falling short with any patients, care managers can easily identify those gaps and make up the difference, ensuring eligible patients are receiving the additional care they need to improve their health and lower their long-term care costs. Automating the documentation eliminates human error in the coding process as well, ensuring billing accuracy to avoid penalties and other reimbursement issues.

CCM is a critical component of the patient-centered medical home as well as population health management. It’s also good medicine, which means more providers than ever are offering this high level of care to patients with multiple chronic morbidities. Why not get paid for all this extra effort that heretofore has been given away for free?

Aprima’s new CCM functionality makes it easy. It’s definitely worth checking out.

Has your organization been taking advantage of CMS’ CCM program? If so, have you found it requires a lot of extra work? If not, why not? Let us know your thoughts in the comments below.

Michael Nissenbaum, Aprima President and CEO


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