.jpg "Daniel Godla")
Approximately 93% of primary care physicians wish they had support to better engage patients with multiple chronic conditions, according to a Quest survey.
However, 85% feel they lack enough time to give patients the level of care they need. Only 9% believe their complex patients receive adequate care for their conditions.
Despite these views, 77% of these same doctors have not implemented a Chronic Care Management (CCM) program to improve outcomes. The survey suggests this is due to three key barriers:
- 43% cited complicated coding for the program
- 37% cited burdensome paperwork
- 25% cited low Medicare reimbursement
Equipped with the right software, providers can create and submit accurate claims to CMS that meet Medicare requirements, as well as optimize revenue and easily monitor the financial health of care management programs.
ThoroughCare is a care coordination platform that helps physicians and care teams do all of this while overcoming common barriers to CCM.
Automated coding
There are five pieces of information required for submitting a claim to the Centers for Medicare & Medicaid Services (CMS), including:
- CPT code
- ICD-10 code
- Date of service
- Place of service
- Provider NPI number
While these may sound straightforward, there are rules around each component. For example, a CPT code and an ICD-10 code are tied together. If a patient participates in CCM, a minimum of two ICD-10 codes are required with each claim because a patient must have two or more chronic conditions to be eligible.
Also, there are rules surrounding dates of service. For example, time-related programs like CCM require a date of service that can’t occur any earlier than the day the patient achieved their billing tier, e.g., 20 or 60 minutes of care. Also, the date of service cannot occur any later than the last day of the month in which the service was provided. And, when additional billing tiers are available, the date of service is the date of the time log that puts the patient at the next tier.
These rules can be confusing. The most common errors are found with assigning CPT and ICD-10 codes.
However, ThoroughCare addresses these coding challenges because the platform automatically assigns the proper CPT codes and includes an easily searchable list of ICD-10 codes for reference.
Automated time logging
Accurate time logging is critical with time-based programs like CCM.
ThoroughCare offers built-in timers and stopwatches that identify the time spent on non-face-to-face clinical tasks. The system easily alerts users of their time status on the dashboard and compiles this time towards monthly billing.
Other data visualizations inform care managers and decision-makers of time logged and goals to meet billing minimums. They also highlight instances when time logging fell short. These include:
- Time log dashboard
- CCM dashboard
- Missed reimbursement dashboard
Streamlined documentation and billing
ThoroughCare's billing and claims worklist provides operational staff with everything they'll need to drop claims in an electronic health record (EHR) or third-party billing system.
Users can export a billing and claim report to .csv or .pdf that meets CMS’ claim information submission requirements.
Additionally, the platform documents a complete audit trail of patient services, streamlining oversight and compliance efforts.
Integrated claims submission
ThoroughCare offers an application programming interface (API) that clients can use to integrate with and drop claims directly to their EHR. With some EHR and API integrations, ThoroughCare can also automatically submit one or multiple claims directly to a billing portal.
Having a clear picture of CCM reimbursement and revenue
Even though the Quest survey found that 25% of physicians believed that low Medicare reimbursements caused them not to participate in CCM, almost half didn’t know CMS pays separately for CCM under the Physicians Fee Schedule.
ThoroughCare provides various educational resources to keep clients up-to-date on the latest care management reimbursement and trends affecting fees, including CCM and CCM for rural providers.
In addition to data visualizations like the claims dashboard, ThoroughCare helps teams assess the economic value of their care management programs, providing insights and analytics to ensure the practice meets requirements and receives appropriate reimbursement for care management services delivered.
ThoroughCare enables complete data-driven oversight and improvement of care management programs
ThoroughCare’s reporting and analytics capabilities provide key performance indicators needed for robust oversight, compliance, and submitting accurate claims.
As a platform built to comply with CMS care management enrollment and coding requirements, our integrated time tracking, APIs, and easy-to-use reports and dashboards address the common barriers to adopting Chronic Care Management.
