Consider these six FAQs about billing for care management services
Care management is all about helping patients prevent and manage their medical conditions. It’s a fundamental vehicle for managing population health. Why? Care management is a team-based, patient-centered approach that includes comprehensive services and activities to help patients with chronic or complex conditions stay healthy and out of the hospital. It also aims to boost patient engagement and may even promote a higher-quality patient experience leading to increased patient satisfaction and patient empowerment.
The best part? In some instances, care management is billable, and it can increase the profitability of your medical practice. Consider the following six FAQs about billing for care management services.
Q: What services are included under the ‘care management’ umbrella?
A: Care management services include advance care planning, behavioral health integration, chronic care management, principal care management, and transitional care management.
Q: What do I need to know about billing for advance care planning?
A: Advance care planning is a time-based service that requires detailed documentation regarding the nature of the encounter, including the explanation of advance directives, the completion of any of those directives (when applicable), who was present, and the time spent during the face-to-face encounter. For more information about billing for advance care planning, view this MLN fact sheet as well as this CMS FAQ about advance care planning.
Q: How can I bill for behavioral health integration?
A: That depends on whether you are using the Psychiatric Collaborative Care Model (CoCM) or another care model. Under the CoCM, a team of three individuals deliver behavioral health services (i.e., the behavioral healthcare manager, psychiatric consultant, and the treating/billing practitioner). This CMS MLN booklet includes more information about billing for behavioral health integration. In addition, these CMS FAQ answer common questions, such as who qualifies for behavioral health integration, who can provide behavioral health integration services, what qualifications are required for the behavioral healthcare manager role, and more.
Q: I spend a lot of time coordinating care for patients with chronic conditions. Can I get paid for this?
A: In some cases, yes. Chronic care management is designed to help physicians bill for care management services for patients with (2 or more) chronic conditions expected to last at least 12 months or until the patient’s death and or that place the patient at significant risk of death, acute exacerbation and/or decompensation, or functional decline. Principal care management is designed to help patients with a single chronic condition or multiple chronic conditions, but focused on a single high-risk condition. Both chronic care management and principal care management are billable, permitted physicians furnish and document appropriate services. For more information, view this CMS MLN article.
Q: What about helping patients transition from an inpatient hospital stay back to their home or other community setting? Can I bill for this?
A: Yes. This is called transitional care management, and it’s a billable service when rendered to patients who require moderate or high complexity medical decision making. It requires interactive contact with the patient within two business days following the patient’s discharge, a face-to-face visit within specific timeframes, and more. To learn more about transitional care management, view this CMS MLN booklet as well as these billing FAQs.
Q: What are some steps I can take now to lay the foundation for providing and billing care management services in my practice?
A: The following five steps are universally important regardless of the specific care management services you hope to provide:
Improve your patient intake process. Having good data at the onset is a critical step because it ensures you can communicate effectively with patients, verify insurance benefits, provide accurate cost estimates, and more. Consider mobile technology that enables patients to scan a QR code using their mobile phone to complete the patient intake process.
Put billing safeguards in place. This includes built-in claim scrubbers to detect and eliminates errors in billing codes, reducing the number of care management claims that are denied or rejected.
Consider analytics software or other risk stratification tools. To provide care management services, you’ll need the ability to pull and aggregate data from your EHR , claims data, and other sources. Can you identify patients who could most benefit from care management services, such as those with chronic conditions or high-risk, high-use patients?
Focus on patient engagement. Does your medical practice use a patient portal and secure messaging? Does it offer educational resources and appointment reminders? These technologies play an important role in engaging patients in care management services.
Build, expand referral networks. Relationships with specialists and other providers are an important part of ongoing care management services. Leveraging these relationships are paramount.
Conclusion
Helping patients lead healthy lives is what every provider strives to do. Care management is one part of that. By leveraging the right technology, practices can improve patient outcomes and simultaneously generate new revenue. Learn how edgeMED can help or visit our Healthy Snacks Blog for more of our expert insights, best practices and industry trends.
