Chronic Care Management Technology and Services Platform: Supporting the Medicare Physician Fee Schedule 2018 Final Rule

Chronic Care Management, Inc. understands CCM better than anyone—we understand the opportunities, the challenges, the workflow, the consent, audit, Medicare regs and policy–we get all of it.  Built by a care management expert physician as a solution for in-between visit care for high risk patients with multiple chronic conditions, CCM is the only solution needed for MSO’s, ACOs, post-acute care—including CCM in long term care—health systems, group practices, and solo practitioners.  Our chronic care management technology supports risk stratification as well as multiple levels of CCM complexity.

Chronic Care Management Documentation & Time Tracking: Audit Success: supporting 2018 Final Rule

Every care management activity — is time-tracked and pulled into in a robust audit trail that meets Medicare’s 2018 CCM requirements. Our system has undergone 3rd party audits and has achieved a perfect scorecard.  Practices have access to a robust reporting module where they can check their progress each month. Our team is clinically integrated with the patient’s practice team, and communicates in both informal, episodic ways based on an agreed upon protocol as well as formalized CCM reviews with the practice team each month.  At month’s end, practices can easily generate a list of all patients that meet time thresholds.  In case of audit, drill down of all time-tracked interactions can easily be shown to the auditor.

CCM Features & Benefits

  • ANNA Connected Care™
    Using mobile / smartphone enabled patient outreach initiated by ANNA, high impact care management questions are asked of patients to determine current risk.  ANNA then triggers live engagement with care team members, physicians and appropriate community resources.
  • ANNA Connected Care™ Provider Platform
    ANNA Connects CCM physicians/providers with regular updates/alerts enabling physicians to review CCM care plans and address identified risks proactively.
  • Robust Reporting Dashboards
    Practices can run a number of analytics on their populations, financial  performance, referral patterns, and other metrics.
  • Person-Centered Care Plan
    Comprehensive insight into a patient’s goals and status. Includes all Medicare required aspects, as well as important assessment tools. Accessible 24/7.
  • My Wishes, My Words™
    This unique feature “puts goals in plain sight,” providing an important context of care direction in a patient’s own words.
  • Discrete Time Tracking
    Robust  time tracking architecture tracks all time spent on CCM in a fully compliant manner. Robust drill down/enhanced reporting is built in, should it be needed for an audit or other purposes.