Bet You Didn’t Know

CMS is reimbursing providers for providing coordinated care services for patients suffering from two or more chronic conditions by way of two separate programs involving Chronic Care Management (CCM) and Remote Patient Monitoring (RPM)

Chronic Care Management (CCM)

• CPT Code 99490 (HCPCS G0511 if RHC or FQHC) Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
  • multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
  • chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  • comprehensive care plan established, implemented, revised, or monitored.

Example of the adoption and usage by providers of the CCM Program using statistics as compiled and reported by CMS:

• Annual number of unique patients (U.S. average per family medicine provider)
  3,279
• Percent of patients covered by Medicare (US average: 21.85%)
  21.85%
• Annual number of unique Medicare patients
  716
• Percent of patients with 2+ chronic conditions (U.S. average 68.6%)
  68.6%
• Annual number of unique CCM patients
  491
• CPT 99490 monthly Medicare Allowed Reimbursement (U.S. Average)
  $39.13
• Estimate annual CCM reimbursement for family medicine provider
  $192,128  Gross

Remote Patient Monitoring (RPM)

• 99457 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. Monthly Medicare Allowed Reimbursement Per Patient - $47.67 (Possible to Contract to 3rd Party “ISYC” under “General Supervision” by the Ordering Physician.)
• 99453 - Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment (on-boarding of patient into program) Medicare Allowed One-time Reimbursement - $16.90 Per Patient
• 99458 - Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure. Monthly Medicare Allowed Reimbursement Per Patient - $39.13

Using the above CMS statistics for the Average Family Medicine Provider in the US and only CPT 99453 for the initial patient onboarding and CPT Code 99457 for the remote physiologic monitoring management services as provided by ISYC, the potential reimbursements to the provider would yield $280,871 NET Annually

ISeeYouCare would provide and be responsible for handling:

• The supply, delivery and training for all FDA Approved Medical Devices to the individual patient enrolled in the program
• 24/7/365 Monitoring and Response to all patients enrolled in program with ongoing communications and reporting using the eDoc-on-Call Telehealth EMR Portal and accompanying Dashboard with the Ordering Physician and their clinical staff
• Submission of Monthly Billing and supporting activity logs for each patient enrolled in the program to the Ordering Physician for submission of claim to CMS

Unique Capabilities of the eDoc-on-call EMR and Cloud-based Telehealth/CCM & RPM Dashboard

• Ability to establish thresholds (Frequency, Minimum, Maximum Values) of all medical device’s parameters by individual
• Ability to establish and set automated Notification of Alert Message for any adverse alert triggered by the thresholds
• Ability to establish and trigger a wide variety of Assessment Questionnaires for any of the 22 recognized Chronic Care Conditions as established by CMS for transmission to the patient via Email, Text and Direct Visual using the Home eHealth Monitoring System (PC/IOS/Android)
• Ability to establish automated transmission(s) of Patient Education Materials from a ‘built-in library’ to the patient relative to unique clinical conditions
• Automatic transmission of Clinical Encounters Summaries to all care providers of record for a given patient in an CCDA format suitable for direct ingestion to every Certified EHR

“If you’re interested in learning more about the ISeeYouCare Program, let us know by clicking on the get a free consultation. In 30 minutes or less, we can explain the program and even give you quick demo. Other people may do CCM and/or RPM, ISeeYouCare Does It Right”

eDoc-on-Call Telehealth Encounter Consult cloud-based EMR.

This physician facing solution was developed in support of Telemedicine and Telehealth in 2009. It supports both Store & forward and Interactive Video Consultation Medical Encounters between a physician and a patient. Much like an HER provides a rich medical data collection and aggregation system to include robust decision support, this cloud-based system was designed to capable of being used as a stand-alone system with the ability to export data back into every Certified EHR in North America. The system includes the following features: (Abbreviated Listing)

• My Encounter Consults – Manages both Telehealth, Chronic Care Management and Remote Patient Monitoring from both In-Network and out-of-Network Physician Offices as well as on demand from Patient/Consumer initiated request for a Remote Consultation. Once any Consultation request has been received or created due to an adverse event associated with a physiological Alert which has triggered, the physician is afforded a complete Medical Encounter Page for use in their response. The system is subscription and cloud-based and includes a native DICOM Viewer for use by provider in connection with patient or referring provider imaging. The system also provides for continuum of care. At the closure of each medical encounter, the system will produce and transmit an Encounter Clinical Summary in C-CDFA format to every member of the patient healthcare team.
• Patient Administration – This sub-system is used to manage a physician’s patient population in regards to the assignment of Medical Devices, and a patient’s usage of said devices to include; Frequency of Use, Low alerts, High Alerts, Notifications of Alerts to what members of the care team and Action Notifications to the patient in response to any abnormal event. Additionally, this is where the physician or care team can assign Disease Management Protocols in the form of Assessments Questionnaires and Patient Education information for transmittal via text and email to the patient. Lastly, from this page view window, the physician can view and graphically trend all of the patient’s physiological data.
• Billing Administration – The eDoc-on-call Encounter Management System provide and embedded Billing Administration program using the medical codes that are automatically generated by the physician during their completion of the Medical Consult Encounter for a given patient. Reports are capable of being generated in either Single or Batch form in both PDF or Excel format suitable for ingestion into the physicians her or Accounting Software for final submission for payment.
• Physician’s Profile Management – This section of the navigation pane provides for the ability setup or change; physicians Password, Update Personal Information, Change Notification Methods and Add or Edit Other Care Team Members and Assign Responsibilities.
• DMP Management Resources – This sub-system in the eDoc-on-call is quite unique in that it provides for the ability to Create Custom New Assessment Questionnaires, Clinical Protocols, Patient Education Information Materials specific to a given medical situation. This is accomplished in such a way as to be capable of creating a given DMP in a matter of minutes by way of pre-formatted and automated “clickable” forms design. Once created, they can then be assigned to a particular field of medical and saved for later recall and utilized as explained above. The eDoc-on-Call DMP Management comes pre-loaded with a rich set of DMP’s for most every field of medicine. These DMP’s represent the licensed work of some of the most recognized health Institutions in North America.

• My Symptoms Checker – This solution represents a Differential Diagnosis and Care Treatment system which is FDA Approved and certified as 95.1% accurate. When being used in conjunction with a given medical encounter, the patients demographics are preloaded, their symptoms if provided by the patient and with one click will return the top ten diagnosis for that medical situation using AI and other like sophisticated algorithms. The system even has the ability to run causative Drugs Analysis and identity possible Bioterrorist Agents and more. Once a given diagnosis is clicked, the system will navigate to various recognized medical resources which provide recommended care treatment or actions for consideration by the physician.
• My Video Chat – This High Definition Video/Audio Conferencing system uses Web RTC technology and is thus P2P based. This system can be used with PC, IOS or Android Mobile devices on demand and includes encrypted protocols for all video and audio from end to end. The solution includes file sharing, text-based chat and the ability to be used with the physicians Scheduler as well as all other commonly used Email Platforms. (Outlook, Google, etc.)
• My Scheduler – This is an all comprehensive and integrated scheduling system calendar for use by the physician and their care team as well as the patient’s portal for use in scheduling a consultation with the physician. A physician can establish their availability both in terms of open time slots for consultation and their general hours of work/day availability.

Other Supporting PC-Based and Mobile Solutions (IOS & Android) Integrated into all of above three solutions include:

My Home eHealth Monitor

My Health Vitals (4 of 20 Screens)

 My Health Mobile (6 of 58 Screens)