COVID-19 has made it a challenging time for our physician practices as volumes have dropped in many clinics. Looking for alternative revenue streams has led to revisiting new or expanded service models, especially those that add revenue under the new paradigm of practicing medicine at a distance. The expansion of clinic services through telemedicine and COVID-19 related services, such as drive through testing, are the most obvious.  Now that we are learning to operate in this new paradigm, we should look towards building revenue streams that practice medicine at a distance.  Not only will these services offer additional revenue, they are more insulated from volume decline during situations when patients are unlikely to go to a provider in-person.

One such potential revenue stream is Medicare’s Chronic Care Management program at your  clinics. If you already have a program, it would be worth a review to ensure you are capturing all opportunities to perform and bill for the Chronic Care Management function.

Medicare’s Chronic Care Management service is a program where a case manager in the clinic contacts their Medicare patients to perform telephonic case management.  These calls are billable to Medicare as a monthly service.  Case managers may also identify services that are needed by the patient at one of your clinics or facility for additional revenue.  The program is designed to improve patient care management for Medicare members (including dual eligibles) that have two or more chronic conditions. Examples of the chronic conditions under the program include, but are not limited to:

Alzheimer’s disease                                     Autism

Atrial fibrillation                                            Depression

Cardiovascular disease                                Infectious Diseases

Hypertension                                               Asthma

Arthritis                                                       Cancer

Autism                                                        Diabetes

Given that two thirds of Medicare members have at least two chronic conditions, the opportunity to improve revenue at your clinics while improving patient care is material.

If you either don’t have a chronic care management program in your clinics or do not have clarity of how the program drives increased revenue from a distance, you may want to revisit the strategy. Here is a helpful link to CMS for additional information:

https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management

or you may contact Trilogy.

 

 

Ed Casteel

Partner, Trilogy Revenue Cycle Solutions

ed@trilogy-health.com

601-405-4641