CMS has implemented coding and payment for medically necessary care management activities that are performed outside of a face-to- face, in-person visit by clinical staff on behalf of patients with complex health care needs. The M-CCM Program:

• Improves care management for patients, physicians, and nurses.
• Creates checklists and protocols to manage chronic diseases for Medicare patients via mid-level nurse telephone visits, which after an initiating visit, are not required to be in person or face-to-face.
• Mid-level nurses work under the direction of a physician and conduct proactive monthly outreach.
• Specific care plans for each patient agreed upon between the care manager (NP), patient, and physician.
• Includes five sets of reimbursement codes which are reported monthly on a timed basis, each set with a base code of 20 to 60 minutes and an add-on code for each additional 30 minutes.
• Results in happier patients, improved care management, and billable events that capture pmpm revenue for providers.
• ACO Care Coordinators can manage and bill Medicare on their member clinic’s behalf for M-CCM activities.

M-CCM will help you reimagine what it means to care for Medicare patients with chronic disease, because it takes care management and makes it proactive and relational, rather than reactive and transactional.

The Difference:

• Patients must explicitly opt-in to the program.
• Specific care management templates and engagement policies are required to make it a billable event.
• Each patient receives at least 20 minutes of telehealth interaction per month.
• Each interaction bills at MAC location reimbursement level. Additional billings are available depending on the level of interaction.
• Billing is under the CPT codes:
  • Single Chronic Conditions – 99424, 99425, 99426, 99437, and 99439.
  • Multiple Chronic Conditions – 99487, 99489, 99490, and 99491.

CPT 99490 is the general code used to determine If you are participating in M-CCM. Check with your billing department to verify if you are currently submitting these codes.

Opportunities

• Significant Financial The pmpm revenue M-CCM delivers can be substantial and its profitability can make a huge difference to your bottom line.
• Improved Patient Care. Positive results focused on care managers and their efficiencies – to increase efficiency.

Patients Love M-CCM

Not every Medicare patient will opt-in the program, but those that do, value having a nurse, NP, or a PA that they can talk to every month. They also appreciate the:

• Dedicated personal care managers.
• Comprehensive care plans.
• Reduced annual and out-of-pocket medical expenses.
• Health goal setting.
• Medication management and support.
• 24/7 support.

Challenges

• There are specific procedures that must be followed to make M-CCM a billable event.
• Implications On Operations. There can be additional staffing requirements and workload.
• Patient Engagement. There are specific policies that must be followed.
• Program Level Implementation. Initial clinic and physician level education, clinical policy, and patient identification are required.

There Are Additional M-CCM Obstacles that Have Proven to Be Difficult to Overcome

• ACO and TIN staffing levels continue to be challenged, depleted, and costly.
• Most TINs believe their ACO has M-CCM covered, but ACO Care Coordinators do not bill Medicare on their member clinic’s behalf for M-CCM activities, because most do not possess the expertise to manage the program – due to its complexity.
• Those ACOs and TINs who participate in M-CCM struggle to increase patient onboarding and demonstrate revenue gains.

M-CCM is Complex

It is a Very Large-Scale Project.

• Who will do the heavy lifting that creates the significant new revenue – You or a professional firm?
• Your organization must overcome complex issues across multiple clinics and/or doctors.
• Must align with the goals of your organization and physicians, which are related – but different.
• Requires the implementation of strategies that are tied to your organization’s culture and relationship with ownership / board.
• Your organization or professional firm must fully “staff up” for implementation.
• The effort must help your organization gain a unique advantage in overcoming the biggest obstacle to success – patient recruitment and onboarding.

This graph illustrates the complexity of a successful M-CCM effort.

 There are very specific patient onboarding policies that must also be followed.

Overcoming the challenges and obstacles and achieving success with the M-CCM program starts with answering a couple of very important questions:

Have you ever considered the M-CCM program?

Because of its complexity, it is prudent and desirable to first test assumptions, define strategies, evaluate data, and develop plans that would enable success.  You cannot just jump into it. Accordingly, a Feasibility Analysis is recommended.  So…

What are your thoughts on having an M-CCM feasibility analysis done for your organization?

Top-Performing TINs and Physicians Should Only Utilize the Services of Top-Performing Professionals.

• Our service provider is the most qualified and the “best-in-class” at identifying M-CCM feasibility.
• Their skillset, strategies, tools, and support provide the structure that ensures M-CCM success.
• Their team is deeply experienced in healthcare and large scale program implementation and operations.
• Their comprehensive understanding of regulatory requirements and advanced proprietary software technology, which the leadership team has a deep in, and continuous updates in response to industry changes make their technology platform crucial for meeting quality metrics and achieving better patient outcomes.

All these points make them ideal for conducting your feasibility analysis and becoming your service provider partner.

M-CCM is a major new initiative for every ACO or clinic that goes down the path. In many ways, it is a lot like a new business venture. Your best chance of success is to find out if it is feasible for you to participate – and align yourself with a team experienced in big initiatives.

Understanding the implications and benefits of the M-CCM program helps in making the decision on whether to invest in a feasibility analysis – very easy.

We will show you what your M-CCM opportunity looks like. We will email you a pdf of a CMS M-CCM Data Snapshot for your organization, which will show you how much more revenue you can capture with the M-CCM program. The summary will break down the numbers for you in very simple language.

It will also have the program CPT codes to check with your billing department to verify if you are currently submitting them and the next step you will need to take.

Click Here or see the link below to request your organization’s snapshot.

In a 30-to-60-minute Zoom call, we will talk about your M-CCM Snapshot, our team, qualifications, and the Feasibility Analysis that will provide you with something that you will be proud to show all your decision makers, ownership, board, and/or stakeholders. In the least case, you can learn about a CMS program you have yet to benefit from.

Click Here to go to our Calendly page to reserve your Zoom call with us. Complete the required fields and when asked purpose of call, click: M-CCM.

Take a few moments to download our brochure and CMS data supporting materials below.

• Live Well A.P.S. Medicare CCM Brochure (pdf).
• CMS MLN CCM Booklet (pdf).
• Medicare Chronic Care Management for Seniors (link).
• CMS Outreach and Education on CCM report (pdf).
• Mathematica 2017 report on CCM (pdf). (This is an important study, but a bit long.  See page 64 for the Bottom Line)