RPM, CCM & More Support – Summary, CPT Codes And Workflow

RPM and CCM – June 15, 2023

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RPM and CCM – Summary, CPT Codes And Workflow

ValueCare Suite | Contact Infos
Ean Shelley: ean@valuecaresuite.com
Brad Klekas: brad@valuecaresuite.com

Okay, we’re gonna go ahead and get started with today’s Office Hours. And as people filter in, they can go ahead and get caught up to speed. So today, we’re gonna do a quick summary of these programs, the core codes that we recommend, yet, pharmacy should start out with using for the first four to six months. And then I’m going to jump into the software. And I’m going to give us a demo of a typical workflow that we would see within value care suite. So for those of newcomers, there’s some other office hours that will help get you more caught up to speed on the general information of these programs. But today is going to kind of be the piece of what is my workflow look like with these programs. And when you have that piece, along with the information of these programs, and understanding how to approach a physician to secure a partnership, it really brings everything together for you guys to see the clear path forward and learning about these programs, securing that partnership, and then scaling with patients as we start our enrollment process. So I’m gonna go ahead and share my screen, we’re going to review one slide, and then we are just going to jump right into software. So here is a very short sample of the CPT codes that we can use with these programs. There’s over eight programs and over 20 billable codes that we can use for these Medicare value based programs. But here we have is a short compilation of what we say is our core codes that we’re going to focus on for the first four to six months. As you guys get up and running with these programs. The key objective is to get 200 patients enrolled. And we would typically suggest focusing on CCM as you start out to achieve that goal. There’s new processes that we’re having to implement in our office. And so focusing on just one program to kind of get your feet under you. And then as you get to 200 patients, then we can go back and introduce some of these other programs like remote patient monitoring, or transitional care management, with those patients that are already enrolled in CCM or we can continue to enroll new patients. So what I’m going to do today is I’m going to explain the program that we’re looking at here, the description of care that we’re providing, and the reimbursement. But before I jump into that, I’ll say at the very core of what we’re doing with all of these programs is providing preventative care. It’s a very new type of care for many of these patients, where we’re being very proactive in reaching out to them. And with that outreach, and everything that we do for these patients, we’re always going to be tracking our time. So anytime that we are communicating with a patient or communicating with someone in their care circle, whether that’s their PCP, a specialist, a nurse, a member of their family, or if we’re in the patient’s profile, reviewing their chart, reviewing their care plan, making goals for the patient, seeing what we discussed earlier in the month, those are also going to be billable activities. Okay, so let’s go ahead and jump into it here. First, we have chronic care management. And to be enrolled in chronic care management, you have to have two or more chronic conditions to be enrolled and have seen the billing physician in the past year, for your first 20 minutes of in between visit care, you’re going to be reimbursed at $62. And then for each additional 20 minutes. In between visit care, you’re going to be reimbursed at $47. Now, we know that in between visit cares pretty broad term, but it’s meant to be broad for Medicare. So it’s anything that takes place outside of that face to face visit with their physician. And anything that happens outside of a visit with the patient or on behalf of that patient when you’re working with others is going to be classified as billable time. So there’s a lot of services that you guys are already providing in your pharmacy that would classify as this billable time for CCM when you’re providing education about a new prescription, or when you’re contacting their physician to get a medication change or increase or decrease the dosage billable time. Next we have complex Well, sorry, I’m gonna I’m gonna backtrack here for a second. You can do a total of 60 minutes of time with chronic care management. So you could bill that first CPT code of 99490 once per month, and then 994392 times per month for a total of 60 minutes. Time, complex CCM is an elevated cause of the CCM program, where you’re going to have a patient that you spend 60 minutes or more time with them. And you’re going to have higher level decision making be involved in that care. So you could have 55 minutes of time accrued by just your typical workflow with that patient from that month, that remaining five minutes of time could come from that higher level decision making, where you have the pharmacist contacting the physician to change medication. Combining that five minutes of high level decision making with the already accrued 55 minutes of time, would allow you to build complex CCM and get that $130 reimbursement. And then each additional 30 minutes of complex CCM is reimbursed at $68. And you can do a total of six hours of time for complex CCM. Okay, and then next, we have remote patient monitoring, or our PMS as it’s mostly referred to. And for the RPM program, we’ve got a device component and a time component that we’re tracking. So for the device component, we’re going to give the patient one or multiple devices. And as long as we collect 16 days of readings from those devices, we’re going to be reimbursed $54. And that can be an accumulation across devices. So if we gave them, for example, a blood pressure monitor and a scale, and we got eight readings from each, that would total our 16 days of readings. However, they do need to be days of reading. So if they take their blood pressure and their weight on the same day, that’s still just going to be one day of reading. So where it’s beneficial to give the patient to devices, is maybe on that second day, they forget to take their blood pressure, but they’re still going to jump on their scale. So we got the blood pressure and the scale reading from the day before. And then today, we got another scale reading. So we would have two days of readings, helping us accrue to our 16 days of readings by the end of the month. Then we have the time codes. So for the first 20 minutes of RPM services, we’re going to be reimbursed $48. And then for each additional 20 minutes of RPM services, we’re going to be reimbursed $39. Now, what is the labor or the work that’s going into remote patient monitoring services. It’s everything that was included in in between visit care for chronic care management, in addition to any time that we spent reviewing the vitals that we’re tracking on those devices with that patient, and that could look like me going in for 30 to 40 seconds every day and reviewing those vitals, see it looking at their chart, seeing if there’s any trends that I noticed, I could do that on a weekly basis, and do five minutes of time every week, reviewing their chart, seeing those vitals seeing if there’s anything I notice. And doing that daily or weekly is going to accumulate to 20 minutes of time, by the end of the month. I’m also going to receive alerts from those devices within the software. Anytime that there’s a reading that’s outside of a parameter that we’ve established for that device. So if I see they have an elevated heart rate, I’m going to get that alert. And that’s going to be put into a workflow for me to contact that patient, review their chart, see if everything is okay. And then from there determine if there needs to be an escalation or a follow up with that patient within the next day or two. To be enrolled in remote patient monitoring is at the doctor’s discretion, where the patient would have at least one diagnoses or chronic condition that we would like monitors. And when it comes to choosing a device, it’s not just giving the cheapest device that we can to the patient. It’s about matching the right device to the right condition or diagnosis that this patient has what are the best vitals that we can provide or get from this device to help us receive the most insightful information that’s going to help provide proactive care to this patient. And then lastly, down here we have principal care management. Principal care management is an identical clone of chronic care management, except you only need one chronic condition to be enrolled instead of two. And the increment of time that we’re working in is going to be a 30 minute window instead of a 20 minute window. So CCM
tends to get all the attention. PCM is kind of the last cousin of the group, but I certainly wouldn’t turn my nose up at PCM if I have a patient who only has one chronic condition to enroll them in peace Em. And I will note as well that you can be enrolled in multiple programs. So a patient could be enrolled in PCM, and RPM, or if they’re enrolled in CCM, they could also be enrolled in rpm as well. And then if anyone as relationships with an FQHC, or RHC, or real health center or a federally qualified health center, they have their own program called general care management. And there is a pretty awesome opportunity there to be able to run GCM with those FQHCs are RHC. So if you have that situation, please reach out to us, I’d love to explain more about the general care management program. Beyond the programs that we talked about right here on this slide, there are additional programs. But these right here will be your best at creating consistent reoccurring revenue for your pharmacy, they’re going to be very consistent month to month, all of these codes reset on the 30th or 31st, at the end of the month. And then you can start again with these programs. But once you have your feet under you, like I said, after six months or so, then we can introduce some of these other programs that are going to increase the ROI, but won’t be as consistent as CCM or RPM would be for you. Okay, I’m gonna go ahead and pause and see if there is any questions here. Looks like we’re good. Okay, so now I’m going to go ahead and share my screen for software. And we can go ahead and start the demo. Okay, so the point of the demo today is to show you guys just a couple of the workflows that you’re going to encounter, we’re not going to do a deep dive into every aspect of the software. But I want you to be able to walk away understanding what are the core activities that myself or my staff are going to be doing daily with these patients. So we’re going to go ahead and start on the far left side with this icon called tasks. And you can think of tasks as your own personal calendar. This is where I have assigned my schedule of patients that I’m going to contact today. So with these programs, we’re accruing time throughout the month to get up to that 2040 60 minutes of time or more with that patient. So after every interaction that we have, we’re always going to save when is that next interaction going to take place, that next interaction could be in a couple of days, in a week, two weeks or next month. But by saving that inner that next interaction, I’m always going to have a calendar that’s continually being built out in the system. And then it says easy as on today’s date, I come into tasks, and I can see exactly who I’m supposed to contact makes for a very easy seamless workflow. Up at the top right here, I can see that these dates in red are past due. So these are patients that maybe I wasn’t able to get a hold of, and I need to reach back out and try and contact them. And then the dates that are in yellow, signify my dates that I have scheduled for today, to reach out to to these patients. And if I scroll down in a date that I have in gray is going to be an upcoming date that I have to contact that patient. And over here on the right hand side, I can easily filter these categories. So I can look at the period today, next weeks next month, priority of low, medium or high or who is assigned to these patients. I’m sorry, now we’re looking at just my patients, but I could easily look at all of my employees and who they’re working with or I could select just one employee. Okay, so now we’re ready to start a care with a patient where I would just click into the patient’s name. And this is going to take me into the patient’s profile. Notice the timer automatically starts when I enter the patient’s profile. So this is now billable time, as I review their chart and prepare to make a phone call in this situation. I come up here at the top and I can see the patient’s name, age MRN number, date of birth and contact information. This red ribbon right here is called a critical note. And it’s just a very quick way to save a note that you’re going to be reminded of that patient every time you come into that software into the software. So here I don’t want to call this patient after 2pm I’ve seen people add symptoms of the patient’s feeling, a list of new medications that might be taking so that we can ask them questions about that new medication. I’ve seen people save a patient’s dog or cat’s name up here, so they can ask how their dog or cat is doing. But it’s a great place to store information. Over here, I can see the programs that this patient is enrolled in. So right now this patient is enrolled in CCM, and RPM. And we’ve got CCM selected as the program that we’re working on right now. But I can easily toggle over to the RPM program, and have this same time applied here if I wanted to. But we’ll stay within the CCM program. And then here I have the timer, there’s a lot of information that we can get from this timer section, I see how much time we’ve accrued so far in this care, I can see the time that we started this care activity app, I can pause if I need to and resume I could also reset my timer. And then down here for time remaining. This is telling me how much time I have until I earn my next billable code with this patient. And these bubbles below represent those codes that I’ve already earned. So the heart with the shield represents my first 20 minutes of time for CCM. And then these two plus icons represent my second 20 minute increment and my third 20 minute increment of CCM for a total of 60 minutes of time. And these two icons here have turned blue, indicating that I have earned those CPT codes already this month with that patient. So I’m just eight minutes away from earning my third billable CPT code for a total of 60 minutes of time. If I needed to enter time manually, I can come down here and click into that and then easily select the time I spent with that patient. And then proceed with saving a care note, this is really helpful in a pharmacy setting when a patient comes in unexpected outside of a planned care conversation to pick up a prescription, they want to ask them questions or review some things with you, you’re able to track that conversation with them as billable time. Okay, moving on here in the central part of the patient profile, we can see who is their primary care physician who is their care specialist. And the care specialist is the person on your staff who is assigned to this patient. And then I can see the diagnoses that this patient has. And I can invite them to the patient portal where they can review their care plan. And if they’re enrolled in rpm, they can see their vitals that we’re tracking as well. And then scrolling down across the middle right here we have all of these separate tabs that we can go into to provide more information on the patient. We can see vitals if they’re enrolled in rpm, we’ve got planned encounters where you guys can run assessments with these patients. Patient Information is the central storage for contact information, program enrollment. Insurance Information. a care plan is a living document within the software that you’re going to update, weekly or monthly on the goals that you’ve established with this patient. It is a semi automated process. So our software helps you start generate that care plan. And then from there, you’ll continue to add to that care plan. And I can dive in deeper into the care plan on on a later date. And then we can store patient documents. So if they already have a care plan created with their physician, or if they have a list of medications or allergies, or any other type of document we can store here in the patient profile. And one other aspect of these programs is this tab right here with the annual wellness visit where we can help prepare the annual wellness visit for the physician. So right now, a WV there’s about 40 minutes to an hour and a half of work that needs to go in before they can see the patient in the actual pwd itself. And right now that is a cost center for the physician to have his staff spend their time preparing for the A WV but we can actually prepare the WV under CCM time. So we turn that prep work into reimbursable time and then they can carry out with the physician the actual annual wellness visit and be reimbursed for that office visit as well. So physicians get really excited when we can start helping with annual wellness visits. Okay, moving on
down here, we can see a list of the total time spent so far this month with the patient. So I’ve accrued 48 minutes of time, and that’s all been allocated towards the CCM program. And then I have a record of all of the notes that I’ve saved with this patient from all of the care activities that we’ve had. If I want to see a longer list of care activities from previous months, I can come over here and I can review previous cares. Going back, as far as when this patient was first enrolled in these programs, I can review goals that we’ve established with the patient within their care plan and see how we’re progressing with these goals. I can see any tasks that I’ve scheduled with this patient on when to contact them. And then I can see on the devices that this patient have has, if there’s any alerts that need to be reviewed. But in this situation, right now, let’s just say I came into the profile to review the patient’s information. And I was going to call the patient and discuss eating more fruits and vegetables today, because it’s summertime, and it’s going to be helpful for their diet. So I had that conversation, I’m now ready to leave my care note, after I place that phone call with the patient, I can come over here to my note area. And I want to point out right now, this log care session is grayed out, I cannot proceed with logging this care session, until I have both a timestamp and a note entered into the system. Those are two things that we always have to have before we can proceed. So I can go ahead and start typing my notes. We spoke about XY and Z with the patient that would be much lengthier if this was an actual patient interaction. And then I’m able to go ahead and log Procare session. But before I do that, I want to show you one really cool feature that we have here where you guys can create customized templates for the workflows that you’re going to do consistently with these programs. And these workflows are these templates are completely customizable. So if I have to do a questionnaire monthly, and I want my whole staff team to perform that same questionnaire, or if I have a lot of diabetic patients, I want to create a diabetic template. So I can have consistent questions that are being asked every month, or multiple times a month, I would just come in here, click into that template. And then here I have a list of questions that I want to review with those patients. And you can like I said fully customize the workflow here. What questions are we asking? How are we inputting those responses? Whether it’s with a single answer a yes or no answer? You can select multiple answers here for some questions. It’s it’s very in depth on how to build out a questionnaire in our software, you can also build out the logic. So for this question, if a patient answer’s no, I don’t need any more information. But if they answer yes, I am going to want some more information. And I can build that logic out to prompt me to get more information or ask additional questions based off of their response. So I can go through, answer all of these. And now I’m ready to complete my care. So I can go ahead and log the care session. And that’s going to populate this wider note field here. And I can continue to expand on my notes over here. I should note that the timer is going to continue to run in the background, while I finish my notes. If I want to notify someone of this note, this is a great internal process. So if I was pharmacy tech, who was handling the day to day workflow, but I wanted a pharmacist to review this conversation that I had with the patient and provide any insights, I can just notify the pharmacist have this conversation and then up here at this bell notification tab, they’re going to be notified that I tagged them in this note and then they can come in and review and provide any insights of if there is additional things that I should have followed up with based on those questions that I got back from the patient. Then I can come down here and say how I contacted the patient by phone, email or other if I had exceeded 60 minutes of time with this patient, I could mark this care as a complex care, which is you remember from the very beginning of the call, complex CCM is gonna get us 60 minutes of time with higher level decision making involved and an average reimbursement of $130 for that 60 minutes of time. So if I check this box It’s going to track all of my previous time that month with the patient, as well as any new time going forward this month, all under the complex CCM codes to ensure that I get the highest reimbursement possible here. And then this is the template that we just walked through with those answers. And then coming down here is where we’re going to schedule our follow up task. And this is where we started this workflow, where we were looking at my calendar view of who I had scheduled to reach out to today, it’s important that I always schedule my next follow up so that these patients stay in this workflow. So I reached out to the patient today on the 15th, I want to reach out to them again on the 22nd. To check in with them, this care is assigned to myself, and the patient doesn’t have any contact preferences added into their profile. If this was an escalation that needed to happen internally, and I needed to hand this off to the pharmacist to follow up with the patient, I can easily just assign somebody else this follow up. And it’s going to show up in their task list for them to contact this patient on that day. If I can also add a follow up note. So if there was something that I wanted to be reminded of next time I go to contact the patient, or if I needed to leave notes for the pharmacist, for him to escalate this issue. So he knew what he was going with, I could add those notes there. And then I would complete the cares that had been previously provided, and go ahead and log the care session. Okay, so a couple things to point out here. Now, we have now completed 60 minutes of time with this patient. If there’s been higher level decision making and involved, I could go ahead and turn this into complex CCM, which would give me a higher payout, as well as give me additional time that I could spend with this patient if needed for the month. And then I can come down here and see the care that we just provided was 11 minutes. Within the CCM program, we left a note we tagged somebody to review that note, and then we reviewed this template with the patient. And we scheduled a follow up for 622. So we’ve got a clear record of everything that we do in the software with with the patient. At the end of the month, a lot of physicians, like a report that we can generate, where it’s going to take all of these notes, put it into a PDF format, and we can upload that back into their EHR. So as needs arise, they have this information within their EHR that they can review. They also can I have access to the software and review that within the patient profile here as well. Okay, excellent. So that is going to stop that workflow. And I’m going to go ahead and talk about a different workflow that is specific to the RPM program. So for RPM, we have a patient who has multiple devices or one device, and they have taken a reading that is outside of the parameters that we’ve established for that device. So something could potentially be wrong. Or there could be an escalation growing with with the patient’s conditions. So we want to review those alerts that we’re getting. So I’m gonna come over here to this Alerts tab, which shows me all of my patients who have taken a reading that’s outside of those parameters. And I am going to jump into a patient profile and review those alerts. So again, very similar to before, the timer automatically starts and it shows me how much time I have remaining to my next earnable CPT code. And I can see that I’ve already spent 40 minutes of time with this patient and earned two CPT codes. Now I can start reviewing the alerts here. They’ve got low SPO, to heart rate of 56, heart rate of 56, and very low activity. So we can jump over here to vitals and start seeing that data that’s coming in from this patient. And I can review heart rate SBO to temperature and steps. And right now we’re looking at the past seven days, but I’m gonna go ahead and bump that out to the past 30 days. So I can see a wider range of data points. As I’m reviewing the data, I can easily see based off of the category, here we’re looking at heart rate, their average, their highest or lowest readings, and what percentage of readings were in range or out of range.
And then all of these device names right here have a cogwheel next to them. If I click into this cog wheel, it shows me the patient’s tolerances specific to that device or that vital that we’re tracking. So right here, everything that’s in In the green is going to be a good reading, we’re not going to receive an alert for that reading everything in the orange or the red is going to be an alert that we’re going to be notified on and need to follow up with that patient. And I can drag and drop these vitals these tolerances around to where they need to be specifically for that patient, which is a very cool feature that’s built into the software to help us provide a more personalized care with these patients. Let’s say I wanted a little bit more insight than the data that I have here, I can go ahead and click into the name of this vital and I’m going to get more information. So I can see a wider chart view of the data points that we’ve collected, I can hover over those data points to see that information. And then over here, I can see the low average and high readings. And what percent of readings for this patient are normal warning and urgent. And then I can see if they’ve had any readings under 50, or over 100, I can see a list of all of the raw data that we’re collecting for this patient. And I can do that for all of these vital points. Okay. So after I’d reviewed the vitals, it would again be a very similar workflow to what we did before I’d reach out to the patient, make sure that they’re feeling okay. And depending on their responses to the question that I asked, I would either need to escalate this issue, or just schedule a follow up with the patient and reach back out to them in a day or two to make sure they’re feeling okay, or just maintain my my usual cadence with this patient and reach out to them in a week or so while continuing to monitor their vitals. So I can leave a note over here, I would also have the option to select a template to review. And then if I need to, I can schedule that follow up. If this is an escalation, I would just easily escalate this to the pharmacist or the head pharmacist to review. And then I would assign that follow up date, it would be put into their workflow. And okay, after this care, I can go ahead and hit Save and Next, hitting Save and Next is going to stop this care is going to auto populate me into the next person who has an alert on their device readings, keeping my timer continuous from one care to the next. So it stopped that care automatically starts my care for this patient. And I can continue with my workflow of reviewing these alerts and going into their vitals. Okay, the last thing I want to show today is going to be this patient Overview tab, where I can gather a lot of information for all of the patients that I’m assigned to, I can easily see patient information. If they have a critical note, I would see that by this red paper sign right here. And I can just hover over hover over that critical note, to be reminded of anything I need to do with this patient. I can also hover over their diagnosis codes to be reminded of what conditions this patient is managing. Over here on this far left hand side, this calendar icon lets me know if I have a scheduled activity with this patient coming up or if it’s past due. And then if the patient account is missing information, I’ll see this little triangle with the exclamation point in it saying that, hey, they’re missing information that’s important to have in the patient profile before we’re able to bill for this patient. coming across here, I can see patient information who their provider is, as well as who their care specialist is. And then over here, I can see how much time I’ve accrued with this patient according to the program that they’re enrolled in. So for this CCM column, I can see the time and I can also see how many CPT codes I’ve accrued so far this month. So for example, right here, I’ve earned 28 minutes of time with this patient, which has exceeded the requirement of my first 20 minutes of time. So this block turns blue, indicating I’ve earned that first 20 minutes of time with this patient. Up here for this patient, you can see that I’ve accrued 60 minutes of time, which we all know is three increments of 20 minutes of time. So I can see that this has turned blue indicating my first 20 minutes has been earned. And then I have my two additional 20 minutes increments here that have been arranged with this patient as well. So I’ve got three CPT codes aren’t here, then we have this gray bubble. So this is telling me that I am 10 Minutes or Less away from earning my next CPT code. So we’ve accrued 38 minutes of time so far this month with this patient. quick math tells me, I only need two more minutes of time to get me to 40 minutes, I only need two more minutes to turn that 18 minutes of time that we’ve accrued into billable time here to have two CPT codes. And then down here, I can see that I have this navy blue icon. And this is telling me that this patient has been enrolled in complex chronic care management for this month. So there’s been some higher level decision making involved and extra time that’s been required to assist this patient this month. So all of this time is going to be classified as complex. Same information over here for RPM, but everything is going to be color coded green, and I can see how many CPT codes have we earned so far this month? This is extremely valuable towards the end of the month when I want to come over here and I can filter this column. And I can see how much time I’ve I accrued with all of these patients.
Okay, and then I can see here, how am I trending into I have, you know, anytime that I can reach out and make sure that these increments of time, turn into billable time, I can clear out those gray bubbles and turn them into blue bubbles. And then lastly, over here, this column stands for days of measurement. And this is tracking my progress towards getting those 16 days of readings within a month. So here, if I hover over this information, I get a pop out, that tells me I’ve got 13 days of measurements achieved, 14 days have passed, and there’s 16 days remaining in this patient’s billing period. So I’m still very likely to get those 16 days of readings. If it turns green, that is telling me that I have already earned my 16 days of readings. And that will be a reimbursable code here at the end of the month. If this icon turns red, that’s telling me that we did not earn our 16 days of readings, and we don’t have enough days remaining in that billing period to still earn those 16 readings. So we’re gonna have to wait till the next billing period starts to track those 16 readings. Okay, excellent. So that was today a very high level overview of a typical outreach workflow of contacting a patient workflow of handling vital that’s higher or lower than what it should be for patient and how to review that process. And then reviewing our patient Overview tab, and seeing how much time we’ve accrued with our patients so far this month. And seeing what that end of month report is going to look like as we’re trending throughout the month. There are other workflows in here. So please reach out to value care suite if you have any additional questions. Or if you want to see a deeper dive into the software. We are happy to help answer any questions and help you guys along this journey of understanding these programs, finding a partner and learning how to scale these programs. Thank you so much for your time, and we’ll see you next month. I’ll pause for a second. See if there’s any questions before I jump off. That’s it. Thank you for having Thanks, everyone.

Date: June 15, 2023
Time: 1:30 pm