Care Management Blog

Over a decade, the Centers for Medicare & Medicaid Services (CMS) tested various value-based innovation models focused on improving primary care. Models like CPC, CPC+, and Primary Care First demonstrated that “comprehensive primary care can lead to reductions in emergency department and hospital visits while better meeting patient needs.”

Medicare’s new program, Advanced Primary Care Management (APCM), moves away from time-based tracking and focuses on reimbursement based on a patient’s risk level. The highest risk level is covered under CPT code GPCM3 and focused solely on any patient who is a Qualified Medicare Beneficiary (QMB).

Medicare Advantage (MA) plans are at a pivotal moment. First launched in 1997, these managed care alternatives for Medicare beneficiaries were designed to reduce costs and improve outcomes.

Annual Wellness Visits (AWVs) have been shown to reduce healthcare expenses by 5.7% for Medicare beneficiaries. In addition to reducing future costs, AWVs provide an opportunity to assess a patient’s health risks and create a personalized prevention plan.

The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for its 2025 Medicare Physician Fee Schedule. It includes a significant change for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Many Medicare billing guides focus on reimbursement requirements but often lack clear steps on how to successfully and accurately bill Medicare for RPM services.

In 2019, the Center for Medicare and Medicaid Services (CMS) launched its Remote Patient Monitoring (RPM) program, to reimburse providers for using digital technology to monitor patients between visits. The program covers collecting and transmitting patient clinical data. It also supports a clinician’s time to review the data and intervene if it indicates a harmful clinical change.

The Centers for Medicare & Medicaid Services (CMS) has released the Final Rule for its 2025 Medicare Physician Fee Schedule. According to a CMS fact sheet, this update continues efforts to strengthen primary care, support preventive care, and promote better access to behavioral health.

The Centers for Medicare & Medicaid Services (CMS) launched the Guiding an Improved Dementia Experience (GUIDE) Model on July 1, 2024. Running from 2024 through 2032, this program is one of the first Innovation Center care models to focus on longitudinal, condition-specific comprehensive care.

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for its 2025 Medicare Physician Fee Schedule.