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September 30, 2015 by Yash Mehta

Changing mHealth through Medicare Chronic Care Management

What is it?
The new Medicare (CMS) reimbursement policy for Chronic Care Management (CCM) has opened doors for Providers and Practices to receive reimbursement from Medicare for managing and caring for patients. This has many implications in telemedicine by incentivizing Practices to focus on providing better care for chronic disease patients using telemedicine for patient follow-up. From a broader perspective, such policies set a precedent for private insurance to follow when reimbursing Practices for use of telemedicine platforms – not just for chronic care.

How much is it?
The new CCM rule requires that a doctor or nurse spends 20+ minutes of clinician time for non face-to-face care coordination per month. Medicare, in turn, will reimburse under CPT 99490 code $40/month for non face-to-face care. This in turn may lead to approximately $250,000 in annual revenue from CCM.

Future Implication
The advantages from this incentivized approach is in some ways profound – encouraged use of telemedicine applications with financial incentive. Furthermore, Practices and Telemedicine provider both benefit greatly from better care of patients as well as gradual acceptance of telemedicine in daily patient care.

While CCM does not explicitly state the use of telehealth/mhealth technology, the requirements laid out for CCM do require the use of such technology to administer non face-to-face care. Furthermore, CCM also requires the use of EHR technology for storing patient demographics, health & medication and other information.

The CCM requirements thereby indirectly layout needs for telehealth technology that will integrate with any EHR used by particular facility. Integration is very critical considering EHR is central to patient health & data management. Another interesting outcome from CCM is ensuring the 20+ minutes of care is accurately recorded – that too requires some innovative approach to recording the time spent by medical staff.

How can telemedicine help CCM?

Within CCM requirements, telemedicine/mhealth need becomes apparent within the following sections:

  • Scope of Service
  • Comprehensive Care Plan
  • Managing Care

On the surface, advantages of using mHealth for CCM are quite apparent from care management, patient engagement, and financial perspectives. However, an in-depth analysis reveals where and how telemedicine/mhealth fits within CCM. The charts below clarify where we believe telemedicine/mhealth technologies can be used within the CCM framework. While certainly not comprehensive, it does provide a good overview of where mHealth fits within CCM. Considering the numerous mHealth applications currently available, the requirements fulfilled by each application will vary.


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