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Chronic Care Management

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CareGPS Health LLC Provides Technology Driven,
Value-Based Care Coordination for
High to Rising Risk Patients.

Chronic Care Management (CCM)

Is a Medicare-approved program designed to assist patients with the management of multiple chronic conditions. CareGPS Health’s Chronic Care Management (CCM) service is a full-service solution designed to help providers improve outcomes and quality measures, especially for populations with costly chronic diseases. CareGPS Health can be your third-party provider of in office CCM services using your current technology or ours to:

  • Identify Gaps In Care: Search patient by patient and act.
  • Identify Your Most At-Risk Patients: Identifying at-risk patient population to better manage this population’s health monthly.
  • Identify Your Rising-Risk: This is your best chance to intervene and drive real value with preventative care.
  • Enable You To Meet MACRA Quality Measures To Receive The New Value Based Incentives.
  • CMS created a list of preventative service that are outsourced very easily. They also provide an attractive revenue stream.

CareGPS Health provides the People, Process and Technology to perform these services compliantly, In-House without your facility adding new staff or out of pocket expense.

Let CareGPS Health begin enrolling your patients & billing CPT code 99490 this month, without any upfront investment or additional staff.

CareGPS Health will provide the trained health professionals needed to maintain the required non- face -to-face care coordination covered services your CCM patients need for a minimum of 20 minutes per month.

nursesExamples of covered services include phone calls and emails to a patient to discuss management of chronic conditions, management of referrals to other providers, management of prescriptions, and ongoing review of patient status.

CCM can only be billed by one provider each month. CCM cannot be billed in the same month that Transitional Care Management (TCM) services are billed.

CCM-CPT code 99490 $45.00 Approximate payment per New Jersey patient per month.
TCM-CPT code 99495 $164.56 Approximate payment per New Jersey patient “Moderate” complexity.
TCM-CPT code 99496 $231.00 Approximate payment per New Jersey patient “Complex” complexity.

CareGPS Health’s in-office staffing and software solutions help you meet the requirements for the Annual Wellness Visit, CCM, Complex CCM, TCM, AWVs, MACRA/QPP, and more. These services are aligned with new CMS best practices and help you attest for MACRA.

CareGPS Health LLC will help improve patient outcomes and drive recurring revenue without the need to increase staff.

managementWe assist providers in creating a better work-life balance, alleviating much of the burden chronically ill patients place on your staff by utilizing our patient-centered clinical care team.

CCM can only be billed by one provider each month. CCM cannot be billed in the same month that TCM services are billed.

Compliant CCM must include all of the following and can only be billed by one provider each month:

  • Informed consent
  • Care management
  • Electronic health record
  • Patient-centered care plan
  • Access to care
  • Continuity of care
  • Communication
  • Manage care transitions
  • Coordinate care with home and community-based providers

TCM services are a combination of non-face to face and face to face services with the initial contact, at least by phone, taking place within 2 business days of discharge. Please contact us to review our service.

Your dedicated CareGPS Health Care Coordination Consultant will turn a compliance strict, ACA mandated process into better outcomes, lower costs, more satisfied patients along with a positive impact on your bottom line. We provide the turnkey service and a billable summary at the end of each month.

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CareGPS Health’s in-office staffing and software solutions help you meet the requirements for the Annual Wellness Visit, CCM, Complex CCM, TCM, AWVs, MACRA/QPP, and more. These services are aligned with new CMS best practices and help you attest for MACRA.

Frequently Asked Questions about Physician Billing for Chronic

  • Care Management Serviceshttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Payment_for_CCM_Services_FAQ.pdf
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