don’t. We’re doing the work. We’re just not getting paid for it. And this program is just creating more work,” Dr. Curran said. He also found himself spending too
much time explaining to patients why they had an extra copay when they weren’t visiting the office. “We’re a small town, and I know my patients, and they know me. And they’d get really unhappy with me. It is a real dilemma.” Nor could Dr. Curran bill for TCM,
which pays more. “Most of these pa- tients are sick enough that they are in and out of the hospital. And in a small town, we are the hospitalists for our small hospital.” TMA officials say most practice management systems do a good job of letting physicians know which servic- es they bill for each month, but some coordination may be necessary. When it comes to crossover with CCM ser- vices, Medicare has indicated it will pay for the code billed first by a physi- cian practice in a given month. For ex- ample, if practices bill TCM first and CCM later the same month, Medicare will deny the latter code, or vice-versa. Now with a better grasp on the
scope of requirements, “we’re going to give it another go because we know we’re leaving money on the table,” Dr. Curran said. “There’s no doubt if you empower primary care physicians like me to take chronic care patients, there’s a world of change in terms of outcomes and cost of care. It’s money I’d love to have if we can just figure out how to capture and document all the things they want us to document.”
ADDED VALUE Any investments practices make now also will work to physicians’ advan- tage in the near future, as many com- ponents of the CCM program overlap with requirements physicians face under Medicare’s evolving quality re- porting programs, says TMA Director for Clinical Advocacy Angelica Ybarra. Currently, of the 250 PQRS mea- sures physicians can choose, roughly
September 2015 TEXAS MEDICINE 49
GET CCM HELP FROM TMA
While many physician practices are likely to be interested in the enhanced revenue and patient care improvements from the Chronic Care Management (CCM) program, they might lack the operational eficiencies, technological in- frastructure, and ability to handle the additional workload. Practices can find help through TMA Practice Consulting and TMA PracticeEdge. To find more information about implementing a CCM
program in your practice, sign up for one of the TMA Medi- care seminars in November and December 2015 or the new webinar series coming this fall. TMA PracticeEdge also is developing a turnkey solution, including patient eligibility identification, structured data recording, and care management services. Interested in learning more about TMA Practice Consulting or TMA PracticeEdge? Visit
www.consulting.texmed.org or
www.TMAPracticeEdge.com.
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