Question about Chronic Care Management CPT code 99490

[Victor85]

Hi everyone, I'm a pharmacist looking to leave the pharmacy profession and invest in a health and medical wellness franchise called RX2Live.
This company has many different verticals to generate income.
One of the one I am interested in is introducing Chronic Care Management (CCM) using CPT code 99490 to PCP. Basically the office would outsourced the CCM service to this company. The company would then charge a fee once the office is reimbursed by Medicare.
In the pharmacy we do something very similar called Medication therapy management (MTM), but its only once a year, where as CCM is reimbursed once a month.

The franchising person sent me some white paper explaining CCM and also this link below. He said that's one of the ad they use to attract doctors.
Chronic Care Management

I just have a few question for practicing doctor's and those who own their own practice before taking the plunge and buy into this company.

Are there many primary care provider actually doing CCM and getting reimbursed by Medicare in house? If this is something that can be done in house, why would you outsourced it to a third party?
Anyone outsourcing your CCM service to a third party company?
If yes, what company do you guys use?
Has anyone heard of RX2Live?

When I googled CCM services there are so many different companies. When I questioned the franchise rep, he told me RX2Live is special because they were able to figure out how to input date into all the different EMR/EHR without having the doctor's office pay a huge fee for EMR/EHR integration. Apparently no other company are able to do this, without the office pay for that integration fee.
I mean I have no reason to believe he's lying, but does this seem possible?

thank you very much for your time.

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[deleted87716]

If this is something that can be done in house, why would you outsourced it to a third party?

Because it's less time-consuming.

Anyone outsourcing your CCM service to a third party company?

We've done both, but we're moving most of it back in-house now that we have full-time care coordinators in the group. I honestly don't do much of it. I think the reward/effort ratio is too low.

what company do you guys use?

American Health Connection

Has anyone heard of RX2Live?

Nope.

I should add that I would take a dim view of any of these companies trying to market their CCM services to non-PCPs. We had a local ortho group in town that started signing patients up for CCM through an outsourcing agency. Since they (as specialists) have no ability to act on any of the information that they would be getting back, it was an obvious money grab. We refused to release any records to them, and formally registered our displeasure (e.g., kiss your referral base goodbye). They stopped doing it shortly thereafter.

 

[FrustratedFamDoc]

Monthly billing of Mcare? Just did some reading and it looks like patients are have to pony up their 20% each time this is billed. There's also a lot of complexity involved and what looks like a lot of overhead.

So what I'm seeing looks like a way to try and skim more money out of an already failing system at little to no actual benefit to the patient, all while soaking a population of already cash strapped seniors. Sounds like a good way to lose good patients, getting billed when they haven't even seen you and all....

Anything I do, I try to apply the mom test to. Would I be happy if my mom called me and told me her fam doc was doing this to her. Answer: no.

 

[deleted87716]

Monthly billing of Mcare? Just did some reading and it looks like patients are have to pony up their 20% each time this is billed.

20% of $40 is $8/month, which you have to disclose when you sign a patient up for the program. If they agree to proceed, then they obviously feel that it's worth it. They can drop out any time they want to, as well. So, nobody's getting "soaked."

As for the "skim more money out of an already failing system" part, this sort of thing is basically the future, in recognition of the fact that a lot of chronic care management takes place outside of face to face office visits (e.g., phone calls, coordination of care, etc.)

There is value in the program, especially for patients with multiple chronic conditions, just not enough to make it worth all the effort, IMO. Personally, I think they should just do away with CCM and increase our E&M.

 

[Victor85]

Because it's less time-consuming.



We've done both, but we're moving most of it back in-house now that we have full-time care coordinators in the group. I honestly don't do much of it. I think the reward/effort ratio is too low.



American Health Connection



Nope.

I should add that I would take a dim view of any of these companies trying to market their CCM services to non-PCPs. We had a local ortho group in town that started signing patients up for CCM through an outsourcing agency. Since they (as specialists) have no ability to act on any of the information that they would be getting back, it was an obvious money grab. We refused to release any records to them, and formally registered our displeasure (e.g., kiss your referral base goodbye). They stopped doing it shortly thereafter.

Can I ask you how much you guys are getting reimbursed after American Health Connection takes their fee?
Also I agree that this should be left to the primary and internist to handle. That's where I would try to target if I decide to buy in.

Monthly billing of Mcare? Just did some reading and it looks like patients are have to pony up their 20% each time this is billed. There's also a lot of complexity involved and what looks like a lot of overhead.

So what I'm seeing looks like a way to try and skim more money out of an already failing system at little to no actual benefit to the patient, all while soaking a population of already cash strapped seniors. Sounds like a good way to lose good patients, getting billed when they haven't even seen you and all....

Anything I do, I try to apply the mom test to. Would I be happy if my mom called me and told me her fam doc was doing this to her. Answer: no.[/QUOTE
I am trying to do my due diligence and from what I can gather, straight medicare patients would have to pay the 20%. However, from what I see in the pharmacy, the majority of patients with 2 or more chronic condition will also have Medicare F supplement that will take care of the 20%. Plus the 2 chronic or more condition population will also have some type of Medicare advantage plan (this is what Medicare is pushing since it relieves Medicare's burden on these patients since they are ran by some commercial plan UHC, BCBS, HUMANA etc... ), and the Advantage plan will pay for this service.
Medicare is a failing system eversince they decided to privatize it. Instead of a complete overhaul, they are patching it here and there to try and fix a broken system. If you are not in a position to accept the change then you will be left behind.
The biggest take away I can see from my research is that CCM was rolled out by medicare a few months prior to announcing they are moving towards MACRA and MIPS, by doing CCM you would have already satisfy many of the MIPS requirements to get the +4 for 2018 and up to +9% by 2020 or 2021 I believe.
If you are not rolling with the time then you could be looking at a -9% adjustment to your medicare reimbursement.

I think it's a great program and not too many primary docs are taking advantage of. If you really look at it, adherence is the biggest reason for hospital admission/readmission. If patients are getting that monthly/twice monthly reminder to take their medication (lets be honest, doesn't matter how great your are on the phone getting 20 minuted in one sitting with any patients is challenging), they will be more apt to tk it.
This is what I go through on a daily basis
Me "Mrs. X I filled this Rx for you 2 months ago, and it was a 1 month supply. Are you taking your meds daily?"
Mrs. X " Ofcourse I do, every day like the doctor prescribed."

I think this program will gain more popularity once the 2017/2017 medicare info comes out and docs are getting (-) reimbursement for not meeting MIPS goals.

The reality is, I just want to get a feel to see if there are a lot of primary doc already performing CCM either in office or outsourcing it through a different company. Also how likely it is to be accepted if they were approach by someone promoting this service.
I want to buy into this franchise, but just unsure of how it will be received in the primary care setting.

 

[deleted87716]

Can I ask you how much you guys are getting reimbursed after American Health Connection takes their fee?

$20. They take half.

 

[Victor85]

$20. They take half.

Ok, It's the same for this company.