Physicians and other qualified providers working within nursing and assisted living facilities can deliver covered care management services, according to The Centers for Medicare & Medicaid Services (CMS). So long as they meet all billing requirements, and the claim is submitted using a specific NPI number. These services include:

A performance measurement strategy evaluates whether a care management program has met its goals by using a set of metrics compared against expected outcomes.

ThoroughCare's clinical team recently hosted a webinar, “The Impacts of Social Determinants of Health (SDOH) on Patient Care and Outcomes.” They were joined by Dr. Maya Bell, PharmD, MBA, Director of Clinical Services at PharmaClin.

Since 2015, the Centers for Medicare & Medicaid Services (CMS) has established several care management programs to improve outcomes and reduce costs for beneficiaries with chronic conditions and higher complexity. These include:

Software should make meeting compliance and value-based care contracting requirements seamless. ThoroughCare was built to not only meet CMS’s care management program requirements, but our existing tools and capabilities were designed to support value-based care coordination and contracting no matter the payor.

Since the Centers for Medicare & Medicaid Services (CMS) began covering Annual Wellness Visits (AWV) in 2011, the value of this yearly assessment has continued to increase.

Nearly 50% of Medicare beneficiaries are enrolled in Medicare Advantage plans. Each of those health plans is given a Star Rating, which has become the cornerstone of consumer rankings, performance assessment, and more than $12 billion in Quality Bonus Payments.

UPDATE (1/8/2025): In its 2025 Final Rule, CMS changed the rules pertaining to HCPCS code G0511. Read here for the latest information. Since Medicare introduced care management programs in 2015, coverage has evolved to provide expanded opportunities for Rural Health Clinics and Federally Qualified Health Centers. Historically, however, new care management programs have been launched without initially including RHCs and FQHCs or with significant restrictions.