Chronic Care Management Success

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How to overcome electronic health record limitations

At first glance, Medicare’s new chronic care management (CCM) billing code, which became available January 1, looks like a major opportunity for primary care practices. But many practices will find it difficult to meet the requirements for billing the code, and a major reason is the limitations of today’s electronic health record (EHR) systems. The Centers for Medicare and Medicaid Services (CMS) will pay physicians roughly $40 per patient per month to provide enhanced care management and care coordination to fee-for-service Medicare beneficiaries with two or more chronic conditions. Patient-centered medical homes (PCMHs) are in a good position to take advantage of this offer, experts say, because they have already changed their workflows to improve care coordination.

However, practices must use certified EHRs to bill the CCM code (CPT code 99490) and the latest systems include features that can support chronic care management. But EHRs are not designed for non-visit care or for collaboration among providers caring for the same patient. Moreover, they lack the data analysis and automation functions that practices need to deliver chronic disease care efficiently.

So even if your practice is PCMH-recognized by the National Committee on Quality Assurance (NCQA), you’ll probably need to do some EHR workarounds and customization, and you may require some additional software to bill CCM. If your practice has not achieved medical home recognition, you’ll face the same technical problems and will have to re-engineer your work processes to take advantage of the code. Only you and your colleagues can decide if doing so is worthwhile.

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