Effective care coordination results from building connections with patients based on respect and trust. Who knows your patient better than you and your staff? Primary care practices have the unique opportunity to build lifelong relationships with patients. It is through these relationships that small incremental behavior changes are possible.
Although Center for Medicare and Medicaid Services (CMS) approved the use of third party entities to assist with the delivery of Chronic Care Management (CCM), it was not their intent to have primary care practices fully outsource their CCM program. In the Federal Register published 11-15-2016, CMS emphasized that “if there is little oversight by the billing practitioner or a lack of clinical integration between a third party providing CCM and the billing practitioner, we [CMS] do not believe that the CCM service elements are actually being furnished and therefore, in such cases, the practitioner should not bill for CCM”.
Using a third party vendor to supplement your program is appropriate. For example, employing a nurse advice service to provide your patients with after-hours access to care information may be very helpful to patients in your practice. However, the day to day care coordination tasks can be done in your clinic. In fact, I would hazard to guess that clinic staffs routinely perform care coordination tasks every day. The provision of care coordination has been incorporated in practice as a concept since the formalization of nursing as a professional practice. However, the process, structure, tracking, and outcome measurements required to establish a care coordination program that meets reimbursement guidelines and contributes to a viable financial practice model is just immerging.
At HealthTechS3, we can assist you in evaluating your current workflow to find opportunities for new processes and implement process adaptations for seamless integration for patients, providers, and staff. We have partnered with CrossTX to bring you the tools necessary to meet the needs of your patients, your workflow, and the CMS billing requirements. To learn more please watch our webinar: Caring for the Patient – Not the Technology found at this link.
Author: Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting HealthtechS3