Chronic Care Management

ScopeData collects, manages and prepares the billing information necessary for clinical information systems while enhancing patient self-care, care coordination and patient communication.

Using the ScopeData App, practitioners can improve care delivery, simplify care coordination, boost patient compliance and connection – and improve general satisfaction for beneficiaries with chronic illnesses.

SCOPE DATA DELIVERS critical medical data and SIMPLIFIES the CCM process:

Interface and display a dashboard within EPIC EMR
Collect live-time data from your patient relevant to their chronic condition
Calculate and monitor important risk factors (i.e. Framingham scores, BMI, Charlson Comorbidity Index)
Monitor and graphically trend patient’s BP, pulse oximetry, blood glucose & weight from the comfort of home
Monitor chronic condition symptoms, medication side-effects, functional and psychological state
Communicate with the patient via a HIPAA-compliant Email and text
Medication reconciliation with Beers Criteria for potentially inappropriate medication use
Provide genetic insight to opioid drug metabolism issues with treatment guidance
Provide genetic dependency risk information
Calculate and monitor RIOSORD (Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression)
Provide CCM pertinent video and educational resources to the patient’s smartphone, tablet or computer devices
Collects MIPS Quality Measures picked up by CCM
Encourages better self-care and healthy behaviors between office visits

Getting Reimbursed

Managing the care of patients with chronic illnesses between office visits has traditionally gone uncompensated. Now practitioners can bill Medicare for CCM services for eligible patients.

Patient Eligibility

To be eligible for Chronic Care Management, a patient must have two or more chronic conditions expected to last at least 12 months - or until death. These conditions would be expected to place the patient at risk for death, acute exacerbation, de-compensation, or functional decline.

Provider Eligibility

CCM services can be provided and billed by primary care physicians as well as physician specialists, physician assistants, and advanced practice registered nurses including nurse practitioners, clinical nurse specialists and certified nurse midwives.

The clinician billing for CCM is responsible for overseeing the services however delegates the data collection and care coordination activities to other clinical staff.

Only one care provider can bill for CCM per beneficiary per calendar month.

The original CPT Code 99490 allows eligible practitioners and suppliers to bill $42 for at least 20 minutes of non-face-to-face clinical staff time each month to coordinate care for patients with two or more chronic conditions.

In addition to CPT code 99490, in 2017 CMS updated the Medicare CCM program and introduced three new billing codes offering providers with further reimbursement opportunities for chronic care management services.

HCPCS code G0506 is a one-time code providers can now bill in addition to the CCM initiating visit.  This code reimburses providers $63 for extensive assessment and CCM care planning beyond the usual effort.
CPT code 99487 is for complex CCM, requiring substantial revision of a care plan and medical decision making of moderate to high complexity. Providers are reimbursed $93 for 60 minutes of clinical staff time.  
CPT code 99489 is an add on code to CPT code 99487 that provides $47 of reimbursement for each additional 30 minutes of clinical staff time.

Out-of-pocket health expenditures are also higher for persons with chronic conditions and functional impairments, persons with activities of daily living (ADL) limitations, and persons who have been hospitalized, when compared with persons who do not have these circumstances.

Chronic conditions and their complications are largely preventable and generally amenable to interventions.

A large proportion of chronic diseases and associated suffering, early deaths, and costs can be attributed to four unhealthy – yet modifiable behaviors:

Lack of physical activity
Poor nutrition
Tobacco use
Alcohol consumption

Chronic Care Management Services address some of the health and financial burdens associated with chronic illnesses for society and individuals.

Incorporate SCOPE DATA into your Chronic Care Management program (CCM)