SOLUTION: Resources

White Papers, FAQs, and Important Links

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Collaborative Virtual Care Drives Medicare Chronic Patient Program Success

Please view the following resources to get educated on Medicare reimbursed services for chronically ill patients and achieve a better understanding of how Collaborative Virtual Care can accelerate the implementation and scaling of your Chronic Care Management program and beyond.

2019 Outcomes Study

Orb Health partnered with a large Federally Qualified Health Center (FQHC) to deliver Chronic Care Management to their Accountable Care Organization (ACO) member population. Significant results were realized after one year of operation including:

  • In the first 9 months of the program, a 54% decrease in ED visits for patients with 6 or more conditions was observed
  • ED reductions result in an estimated $6.2 mm in net healthcare savings for every 1,000 patients
  • Increased both Fee For Service revenues from CCM-related CPT codes and profitability in Value-Based Care programs

Download the white paper here…

Introduction to CCM

Strategic CCM Vendors offering Collaborative Virtual Care solutions accelerate implementing, managing, and driving impact to patient outcomes, cost savings, and value-based profitability.

CMS Chronic Care Management services was purpose-built to help FQHCs/RHCs improve the outcomes of patients with chronic conditions through reimbursable non-face-to-face encounters.

The CMS requirements for CCM implementation, servicing, reimbursement, and compliance represent significant overhead in building an in-house program.

Strategic CCM Vendors offering Collaborative Virtual Care solutions accelerate implementing, managing, and driving impact to patient outcomes, cost savings, and value-based profitability.

Download the white paper here…

CMS 2019 CCM Guidelines

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.

This booklet provides background on payable CCM service codes, identifies eligible practitioners and patients, and details the Medicare PFS billing requirements. including the updated CPT codes beginning January 1, 2019.

Download the white paper here…

Navigating CCM Compliance

Chronic Care Management (CCM) programs are necessary for better patient outcomes. However, there is a huge gap in written direction from Centers for Medicare and Medicaid Services (CMS) on how to effectively drive program quality and maintain compliance.

The complexities and somewhat unclear directions from CMS regarding CPT 99490 for Chronic Care Management have continued to be a concern for providers and will surely lead provider practices to inaccurate coding and/or documentation.

This white paper reviews the complexities and pitfalls of a Chronic Care Management program and how to avoid them.

Download the white paper here…

Collaborative Care - The Key to Effective CCM

Most people think of collaboration as just being between the patient’s PCP and other levels of physician care, such as specialists or hospital-level care. However, physician practices have several care team members– front and back office staff, medical assistants, nurses, and, of course, the providers. Disconnects between the patient’s PCP, specialists, and hospital care team created huge gaps that often resulted in disjointed care that affects the patient’s overall outcome.

From a chronic care perspective, the pharmacist, lab and diagnostic providers, as well as home care nurses and therapists, hospice staff, family members, and many other community resources that help support patients at the primary care level must be included.

This whitepaper will discuss these gaps and how to fill them in a collaborative manner to maximize CCM program success.

Download the white paper here…

Driving CCM Patient Outcomes in Federally Qualified Health Centers (FQHCs)

HSRA’s Federally Qualified Health Center (FQHC) program provides tens of millions of Americans in underserved communities with quality, affordable health care and other services via primary care health clinics.

Since January 1, 2016, FQHCs have been able to receive additional payment for the cost of Chronic Care Management (CCM) services when at least 20 minutes of qualified CCM services are furnished to a Medicare patient who has two or more chronic conditions.

An estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions.

This whitepaper will discuss the opportunities and challenges a FQHC has in Chronic Care Management.

Download the white paper here…

Medicare Shared Savings Program Measurements

This document describes methods for calculating the quality performance benchmarks for Accountable Care Organizations (ACOs) that are participating in the Medicare Shared Savings Program (Shared Savings Program) and presents the benchmarks for the quality measures for the 2019 quality performance year.

It is an update to the “Quality Measure Benchmarks for the 2018/2019 Performance Year” document
released in December 2017 and reflects the 2019 quality measure set, including new benchmarks for three measures that phase into performance for the 2019 performance year. Under the Shared Savings Program, new measures are set at the level of complete and accurate reporting for the first two years before phasing into performance. The benchmarks for each measure, along with the phase-in schedule for pay-for performance and applicable performance year for each measure.

Download the whitepaper here.