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650.799.6005|www.careskore.com|[email protected]
2017CCMChanges:SimplewaystobuildathrivingCCMsolution
2017 CCM modifications done by CMS
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Why
Why did CMS introduce these changes?
What
What arethe modifications?
How
How should you as a provider act on these changes?
Why did CMS makes changes to CCM in 2017?
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Why
1Early2015CCMannouncespaymentforCCM– nonfacetofaceservices. 3
Jan2017CMSrelaxesrequirementsforCCMandreleasesnewbillingcodesforpatientsrequiringmorecare.
2 Late2016LowadoptionrateofCCMservicesOnly1%oftheeligiblebeneficiariesreceivedthecriticalservices.
What caused the low adoption rate?
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Why
• Betterclinicaloutcomes• Qualityratings
• InsufficientReimbursement• Lackofawarenessregardingtheopportunity• Complianceconcerns
BARRIERS
BENEFITS
2017 CMS changes to CCM
• No required consent form
• CCD does not need a specific/ structured format
• Communication must be documented in medical record, not necessarily EHR
• No 24/7 access to care plans needed
Billing Rules:Simplified
• Payment for complex CCM (CPT 99487) after 60 minutes at rate of $92.66.
• Can bill (CPT 99489) for each additional 30-min increment spent with patient.
Complex CCM:Covered
• CMS acknowledges the time required to develop a care plan.
• Can bill (GPPP7) an extra $63.88.
Care Plan Development:Covered
E/M Services:Prolonged
• New codes proposed• CPT 99358 for 60 minutes
of E/M services billed at $113.41
• Each addition 30 minutes under CPT 99359 billed at $54.38
What
Automated & Integrated with your current workflow to ease your resource needs
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RevenueProjection
Automation OutcomeAnalysis
ResourceRequirements
TechnologyEvaluation
Workflow
AutomaticallyidentifypatientsforCCM,trackalltherelevantcodesintheworkflow,automatepatientengagementandoutreach.
Whatstepscanyouautomate?
Workflowshouldbeeasyandintuitive;ensuringthatyourpracticecanbefunctionalinthematterofweeks.
HowdoesCCMintegrateintoyourexistingworkflow?
Lotsofnewcodes;timetracking.CareSkore’s platformseamlesslyintegratewithyourworkflow.
Whatareyourtechnologyneeds?
SucceedwithCCM
Roughly$60permonthperpatient..CareSkore’swebsitehasalinkto2017CCMcalculator.
Whatistheimpactonyourrevenue?
CCMhasaverypositiveimpactonqualityratingsandreducing
hospitalizationandreadmissions.
HowdoesCCMimpactyourclinicaloutcomes?
Evaluatewhatresourcesneeds;Wouldyouwanttooutsourcethis
effort?
Howdoesthisimpactyourinternalresourceneeds?
How
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Opportunity
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Chronic Care Management
Number of Medicare Patients 10000Medicare patients with 2 or more chronic conditions 67%% of complex CCM patients 20%Zip Code 60540Monthly time spent for Complex CCM Patients (in Minutes) 60Monthly time spent for Non Complex CCM Patients (in Minutes) 20Total CCM Revenue (Monthly) $ 379,717 Total CCM Revenue (Annual) $ 4,556,608
**DatafromJanuarytoOctober2016
How
WHY CARESKORE ?
ReductioninNoshowsandCancellations
42% 16%
No-show and Cancellation
ReductionFor a 50 physician clinic
1% reduction in reducing now show and cancellation typically results in $650/physician/month
Estimated annual revenue of $400K
Readmission Reduction
Average cost of a readmission is $13,500
1% reduction in 30 day re-admission of Medicare and value based contract patients
Estimated savings are$0.5M
Improved Chronic Care Management
Based on 2017 CMS changes
1000 enrolled and billed CCM eligible patients
Estimated annual revenue is $700k
Higher Patient Engagement
Reduce readmission
Manage behavioral conditions effectively
Ensure compliance
Estimated increase in Patient Engagement 35%
Reductionin30day
re-admissions
Potentialrevenuefor10,000patientsacrossthesystem
Highermemberoutreachachieved
throughbi–directionalcommunication
35%$4.6M
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CareSkore offers end to end population health
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Technology
• Machinelearningpoweredpredictiveanalytics
• Personalizedclinicalpathwaysatdischarge
• Artificialintelligencebasedpatientengagementplatformthattouchesalldischargedpatients
Services
• ClinicalstaffcomprisedofNurses,CaseManagersandCareCoordinators
• Ensureallpatientsarefollowedthroughwithacareprogram
• Medicationreconciliation,postdischargeappointment,postdischargepatientcommunicationviatext,IVR,careteamphonecalls
