Revenue Cycle Enhancement

Revenue Cycle Enhancement with Chronic Care Management (CCM) Services through PCCM, LLC

In January 2015, CMS implemented a new chronic care management code (99490) that reimburses at an average rate of $43 per member per month.  For a Primary Care Physician with 200 participating Patients using PCCM services, this results in a $60,000 yearly revenue increase with no upfront costs for the practice.  Visit our CCM Calculator for more examples at Revenue Calculator 

CCM drives Patients to the practice for well visits, same day sick, disease management follow-ups, post discharge visits and preventative care needs.  Care Coordinators focus on the value of face-to-face patient visits with their providers ensuring the patients are scheduled as needed.  Preventative care is scheduled by the Care Coordinators who will also provide patient education on the importance of these essential visits.  Increasing preventative and well visits drives additional revenue to all avenues of ambulatory and outpatient care services.

Control and Reduce Patient Utilization with 24/7/365 Nurse Availability and Condition Education

PCCM offers 24/7/365 Care Coordinator availability for Patients and their Providers.  Patients are encouraged to reach out to their Care Coordinator with any medical concerns or questions before, during and after clinic hours.  Nurses are available 24/7/365 to assist Patients with medication management and medical questions that, unaddressed, may otherwise result in a Patient visit to urgent care, the emergency room or a hospital admission.  PCCM Care Coordinators work closely with each Patient’s entire healthcare team to ensure their access to the appropriate care at the appropriate time.

Relevant Patient education is one of the keys to avoiding unnecessary utilization. PCCM Care Coordinators provide disease specific education for participating Patients. Additionally, 24/7/365 access to a Care Coordinator via telephone ensures Patients have real time assistance when deciding what type of intervention is necessary given particular symptoms they may be experiencing at a given time.  For example, diverting a Patient from the ER and bringing them in for a next day clinic visit for symptoms related to a UTI could result in a cost savings of $1800. (Avg costs: $200 office visit, $2000 ER visit)

Proactive Care Leads to Better Outcomes

Chronic Care Management promotes proactive care versus reactive care through monthly Patient contacts with the Care Coordinators at PCCM.  Care Coordinators reach out to and work with each participating Patient for a minimum of 20 minutes monthly to establish healthcare goals based on their physician’s care plan.  Chronic disease management and preventative care are the focus of each visit to ensure a Patient is engaged leading to better health outcomes.  Better outcomes are a result of proactive care and early detection and diagnosis of chronic diseases allowing for care plans and education to occur before an acute issue arises.

*article: ER visits for UTIs Add Almost $4 Billion A Year by Henry Ford Health Systems