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Chronic Care Management

Medsien’s comprehensive CCM solution delivers a quality experience to patients living with chronic conditions.

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Efficient implementation through seamless integration
Increased production with recurring revenue streams
Dramatically improved patient quality of life

Improve patient satisfaction

Partnering with Medsien increases access to quality care with remote patient outreach, education and enrollment. Our advanced solution optimizes your CCM program, keeping patients more engaged with your practice.

Reduce administrative burden

Having our care team regularly check in with patients on your behalf means you can delegate your workload to CCM experts while knowing every interaction is logged the moment it happens.

Scale at your own pace

Medsien's flexible model allows you to scale your CCM program as you reach more patients and expand your business, ensuring the overall success of your practice without any upfront investment.

Connect seamlessly with our comprehensive EHR ecosystem

With an ever-growing number of technology integrations, you can get up and running with Medsien in a matter of days.

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We have a very simple implementation process for our CCM solutions and can go live within a week

Our team will manage all the aspects (eligibility, announcements, enrollment, etc.) so this will not take any time from you or your staff.

1

Eligibility

Medsien intelligently identifies your patients' eligibility based on their chronic conditions and insurance coverage to maximize your practice coverage.

2

Enrollment

Medsien's Enrollment Specialists contact your patients on your behalf and walk them through the enrollment process effortlessly.

3

Engagement

Every one of your patients will be assigned to a dedicated Certified Medical Assistant to improve engagement and deliver personalized care to your patients.

“I am impressed by the professionalism of the Medsien implementation. Medsien team set up our CCM so that it fit into our existing workflow. They told us exactly what to expect…there were no surprises. They have been a pleasure to work with as they are prompt and look for solutions to always improve our workflow and communications.”
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Contact us to see Medsien in action and learn how your organization can reimagine remote care management.

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Frequently asked questions

Everything you need to know about chronic care management.

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What is chronic care management?

Chronic care management (CCM) is a remote touchpoint in between visits for patients with 2 or more chronic conditions. This includes at least 20 minutes of care management throughout the month. A dedicated care partner communicates via phone or text to coordinate care and help with patient requests.

What are the benefits of chronic care management?

Comprehensive chronic care management benefits patients with 24/7 access to physicians and clinical staff who can meet their urgent and ongoing needs. CCM also benefits practices by electronically capturing all patient interactions for real-time continuity of care.

What are examples of chronic care management?

According to The Centers for Medicare & Medicaid Services (CMS), a comprehensive chronic care management plan typically includes but isn’t limited to: an expected outcome and prognosis, measurable treatment goals, cognitive and functional assessments, and symptom and medication management.

What are the requirements for chronic care management?

Before CCM services can start, CMS requires written or verbal patient consent, as well as an initiating visit for new patients or patients the billing practitioner hasn’t seen within 1 year. CCM services aren’t typically face-to-face and allow practices to bill at least 20 minutes or more of care coordination per month.

What conditions qualify for chronic care management?

Eligible CCM patients must have 2 or more chronic conditions expected to last at least 12 months and place them at significant risk of death or functional decline. Conditions that qualify for chronic care management include, but aren’t limited to: Diabetes, Hypertension, Chronic Kidney Disease, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), Depression and Anxiety and more.

How long does a chronic care management plan last?

To receive CCM services, patients must have 2 or more chronic conditions expected to last at least 12 months or until their death.

How much is reimbursed for chronic care management?

For 500 enrolled patients, Medsien’s CCM solution can guarantee $250,000+ in additional annual revenue. With our accurate, automated billing and coding, we achieve an average monthly reimbursement rate of 98%.

What are the CPT codes for chronic care management?

Applicable CPT codes for chronic care management services include 99437, 99439, 99487, 99489, 99490, and 99491. You cannot report complex CCM and non-complex CCM for the same patient in a calendar month, and time counted toward the CCM service code cannot be counted for any other billed code. Refer to CMS.gov for the latest updates.

How do I start a chronic care management program?

Medsien’s CCM solution makes it easy to deploy a chronic care management program in as fast as just a few days. Reach out to our team of CCM experts today to get started.

How do you introduce chronic care management to patients?

Inconsistent program management can result in annual losses of 25-50%, but practices that partner with Medsien achieve an average annual patient retention rate of 95%. Request a demo to learn how Medsien seamlessly handles patient enrollment.

Blog and resources

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Chronic Care Management (CCM) Overview & Benefits

The Centers for Medicare and Medicaid Services (CMS) defines chronic conditions as those in which the patient is at significant risk of death, acute exacerbation/decompensation, or functional decline, and are expected to last until the death of the patient.

Transitional Care Management (TCM) Overview & Benefits

Transitional Care Management is a program designed to support and track Medicare patients in the 30 days following discharge from a hospital or treatment facility.

Annual Wellness Visit (AWV) Overview & Benefits

The Annual Wellness Visit (AWV) is a Medicare specific annual health status check where patients have vitals and health status indicators assessed, to provide an opportunity for earlier support and intervention for chronic conditions or concerns.