Chronic Care Management requires so much time and effort, and if one has to document that period to bill Medicare, it can become a problem at times. Perhaps you attempted to implement a program but your staff could not dedicate the time, or perhaps there was a low turnout for enrollment. Maybe the billing requirements looked like too much work, or the program never became profitable.

If those scenarios apply to you, you are not alone. Many Chronic Care Management reimbursement programs fail to show a profit for these three reasons: Many Chronic Care Management reimbursement programs fail to show a profit for these three reasons: 

Overworked Internal Staff

A good Chronic Care Management program demands a lot of work from your internal staff. Every patient in the program should have at least 20 minutes of non-face-to-face communication per month through phone or email, and the staff members should also document the time spent on arranging referrals, reviewing labs, or speaking with home health nurses. 

Reimbursement is a monthly process that needs documentation and billing, and the staff members will also have to spend time educating the patients about their enrollment in the program. Too many practices, it is still an extra load for internal staff members who get overwhelmed with their work.

Low Enrollment

The Medicare CCM reimbursement requires the practices to enroll patients and show that they agreed to be part of the program. This can be a daunting task because a co-pay is made when receiving the services. Some patients are reluctant to incur an additional cost while others may not trust a new program that goes beyond the standard services which the patient expects from a doctor or nurse.

Inadequate Technology

Medicare’s chronic care management reimbursement program mandates that the participating practices offer patients care plans in an EMR system that is available 24/7. The system ought to identify the particular information that should be claimed for reimbursement and it must also be capable of integrating information from other providers. In some cases, for some practices, it is more costly to invest in proper technology that would cater to the costs of the practice. 

How to Create a Profitable Program Without Straining Your Team

Medicare also eased some of the conditions required for reimbursement with less effort consumed in documenting the required information and minimizing the program’s complications. However, what would you do when your practice is still not able to generate enough profit for the program? How can you flip the script without adding more stress to your employees’ plates or causing them more agitation? 

Educate Patients

Many patients need to be made aware of the advantages of chronic care management. Perhaps they believe that they do not need more supervision once they leave the hospital or they have no idea how the program will affect them. Making people aware of the benefits of having 24/7 access to their care plans increases long-term health, reduces in-person appointments, and helps in increasing engagement.

Launch a Strategic Enrollment Program

Second, patients do not participate in the program because they lack adequate information about the program. Some of the strategies that you can employ include; preparing brochures, putting up a poster in the waiting area, and explaining to the patients about the study verbally. 

Use a Dedicated Staff Member

Some practices determined that the additional documentation and phone calls necessary for Medicare reimbursement are too time-consuming for the personnel. One way around this problem is to hire a staff member to manage the program full-time. This has a two-fold advantage: more time is available to invest and it also takes the burden off staff members who already have too much to do. 

To sum it up, for most practices, the simplest scenario of establishing a profitable chronic care management program implies cooperation with a third-party management company like Gen by Gen Health.