Chronic Care Management Revenue Cycle Services

Chronic Care Management

BrightDrive HCS can help you get reimbursed for taking care of your chronic disease patients not only making an impact in the quality of their lives but also making sure that your practice is compensated for valuable time spent keeping these at risk patients out of the hospital.

Physicians may spend significant time managing care for patients with chronic health conditions. In 2015, CPT® introduced a code to report these services. To gain payment, both the patient and the documented care provided must meet extensive conditions.

Dandelion seed soaring in the wind

The starting point for a successful program must include:

• Care management services are provided by clinical staff, under the direction of a physician or other qualified healthcare professional.
• These management and support services are provided to patients who reside at home or in a domiciliary, rest home, or assisted living facility, and may include establishing, implementing, revising, or monitoring the patient’s care plan; coordinating the care of other professionals and agencies; and educating the patient or caregiver about the patient’s condition, care plan, and prognosis.
• The physician or other qualified healthcare professional provides or oversees the management and/or coordination of services, as needed, for all medical conditions, psychosocial needs, and instrumental and basic activities of daily living.

Care management activities performed by clinical staff typically include:

Communication and engagement with patient, family members, guardian or caretaker, surrogate decision makers, and/or other professionals regarding aspects of care
Communication with home health agencies and other community services utilized by the patient
Collection of health outcomes data and registry documentation
Patient and/or family/caregiver education to support self-management independent living and activities of daily living
Assessment and support for treatment regimen adherence and medication management
Identification of available community and health resources
Facilitating access to care and services needed by the patient and/or family
Management of care transitions not reported as part of transitional care management
Ongoing review of patient status, including review of laboratory and other studies not reported as part of an E&M service as noted above
Development, communication, and maintenance of a comprehensive care plan

At BrightDrive we understand that the billing provider must establish and implement a comprehensive care plan, and that plan must be continuously monitored and revised, as necessary for patient care. We know how to appropriately capture this information as well as guide the provider to meet the metrics to ensure reimbursement of their services.