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Return on Investment Comparison of Three Payment Models for Chronic Care Management Under Medicare in a Northwestern Physician Hospital Organization
Chronic disease is the most prevalent and costly health condition. The coordination of care provided to those with multiple chronic conditions (MCCs) is suboptimal and fragmented. This population is among the highest utilizers of healthcare, and accounts for the majority of Medicare expenditures annually. Chronic care management (CCM) programs represent evidence-based initiatives shown to improve outcomes, reduce hospital and emergency department utilization, and reduce healthcare costs. Centers for Medicare and Medicaid Services (CMS) have provided various payment models for reimbursement of CCM services. Primary care practices have stated that inadequate reimbursement and confusing payment models are barriers to CCM implementation.
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Guidelines on Billing and Claims for Effective Chronic Care Management
These guidelines would help the clinicians to - Identify what CCM codes & modifiers are available for use by your healthcare setting - List possible billing errors and how to avoid denials on CCM …