Chronic Care Management


Profit without having to do anything.

Many of you may have heard by now that as of January 1st, 2015, Medicare will reimburse physicians for Chronic Care Management Services. Essentially they will pay $42.00 per patient per month if you provide 20 minutes of care outside of the office. As always, there are other more specific requirements that you would need to comply with in order to qualify. If you are like many of the doctor’s I have worked with in the past, you are already up to your eye-balls in regulations – more money is just not enough motivation. No worries – I get that.

Even with this being the case, there is no reason that you or your patient’s have to miss out on these services. There are a handful of organizations, like Transition Med out of Indianapolis, that are willing to provide this care for you and provide you reimbursement for each patient that signs up. They have spent the time understanding the requirements and have tailored their operations to meet the needs of your patients and the government.

One big concern is Anti-Kickback – providers cannot get paid to “sell” their patients to other companies or profit from referring them to other providers. Obviously these groups are sensitive to that piece of legislation. To avoid this, your office would be performing all of the billing for these services under your own name using “incident to” billing. You would essentially be contracting with this organization to provide these additional services in the same way that you might contract with a locum provider while you are away on vacation or sick leave. Ultimately, you are still responsible for this patient and you are still their primary provider.

Just like any business, every company performing these services has their own pricing structure and their own spin on how they deliver care. I have put together a sample pricing structure so that you can begin to understand the benefits to your practice should you choose to go with an option like this. This model assumes that you receive $15 out of the total $42 payment. The AMA estimates the average provider has roughly 500 Medicare patients. Of these, usually two-thirds of the population have two or more chronic conditions that would qualify for these services.


500 total Medicare patients * 2/3 population with 2 or more qualifying conditions = 330 qualifying patients
330 qualifying patients * $15 Medicare payment = $4,950 per month
4,950 per month * 12 months = 59,400 per year

Ok, now are you with me? $60 thousand in additional income and all you have to do is send a claim. Now, let’s look at the added expense of sending that claim. We will assume here that the biller is receiving $15.00 per hour and it takes 5 minutes to send each claim and post the payment when it is returned.

330 qualifying patients * 10 minutes per month = 1,650 minutes per month
1,650 minutes per month/ 60 = 27.5 hours per month
27.5 hours per month * $15 dollars per hour = $412.50 dollars per month
$412.50 dollars per month * 12 months = $4,950 per year

Overall, this adds very little overhead to your practice. For less than $5,000 in additional overhead expenses, you have the ability to bring in roughly $55,000 more per year. Again, this is a very small effort on your part and your patient’s are able to benefit a great deal from the extra attention each month.

Additional Reading
Want $100,000 more per year? Provide Chronic Care Management Services.
Step-by-step guide to billing Medicare for Chronic Care Management Services.

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