New Sources of Revenue and Chronic Care Management Software Drive Care Coordinator Hiring

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Propelled by the Affordable Care Act (ACA) and the move towards fee-for-value care delivery models versus fee-for-service, chronic care management (CCM) services have the potential to significantly reduce healthcare spending. Patients who have the education and training they need to manage their chronic illness will incur lower healthcare costs. The overall goal of CCM services is capitalize on this concept and improve self-care behavior by providing education, counseling, and support in between office visits.

New Revenue Sources for CCM services

Starting in 2015, Medicare introduced current procedural terminology (CPT) code 99490 which reimburses providers about $42 for 20 minutes of staff time spent providing CCM services to Medicare patients with 2 or more chronic conditions. In 2017, Medicare added 2 new CPT codes for Complex CCM Services, 99487 and 99489. As explained in the table below, with the addition of these 2 new codes, providers can increase their reimbursement per month per patient to $140.

The billing practitioner can not report both complex CCM and non complex CCM for a given patient in a given month
CPT CodeAverage Reimbursement/
Patient/Per Month
Complex CCM
$94.00The patient’s condition requires moderate or high complexity of decision-making. Clinical staff, directed by a physician or qualified provider, provide 60 minutes of service per calendar month.
Complex CCM with Additional Time
$46.00The requirements of CPT code 99487 are met and the patient receives a minimum of an additional 30 min of CCM services per calendar month.
Total Potential Revenue for Complex CCM Services$140.00 per month per enrolled patient

Transitioning to Value Based Care

“These components of the ACA that are meant to help reduce costs in healthcare are right on the money,” says Scott Anderson, CEO of My Care Coach, a company that provides outsourced care coordinator services to hospitals. “The idea of helping doctors align compensation to manage conditions, versus just paying them to work on acute flare-ups, is much more of a correct approach to care.”

Of course, the problem for many healthcare organizations is that it won’t be easy to meet Medicare’s requirements without stretching already limited staff resources or hiring costly new staff. This is where the care coordinator comes in.

The Care Coordinator’s Role

care coordinator

Whereas the physician knows what needs to be done clinically and instructs the patient to do so, up to 80 percent of the medical information provided to the patient is immediately forgotten. Furthermore, time constraints prevent staff from following up. The care coordinator fills this gap in care by working closely with the patient to improve health outcomes.  

Unlike the physician, whose time is extremely limited, the care coordinator has time to develop a relationship with the patient and provide the necessary clinical information after the patient’s visit.

The care coordinator not only relays the physician’s directives via a care plan, but he or she also works towards meeting the patient’s health goals. Additionally, the care coordinator is available to provide support and guidance in modifying behaviors.

The activities of the care coordinator are documented and organized in a chronic care management platform. Choosing the right chronic care management software will enable your organization to provide optimal chronic care management services.

With chronic disease management and population health management becoming the focus of government initiatives to reduce healthcare spending, it is likely we will see all healthcare organizations looking to hire care coordinators in the near future. Those who do so sooner will be ahead of the game.

Learn more about Bridge Patient Portal’s Chronic Care Management Solution.

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Rebecca is not only a Customer Relations specialist at Bridge patient portal, but has also worked extensively as a Pediatric Nurse Practitioner. She is an expert in both the technical aspect of portal creation and its practical application.

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