NextGen Office Care Management Support Services: CCM, RPM, and BHI

In 2015, the Centers for Medicare and Medicaid Services (CMS) recognized Chronic Care Management
(CCM) as a critical component of care for people living with two or more chronic conditions—which is
estimated to be two-thirds of all Medicare beneficiaries. Chronic illness is costly—data shows that
about 30% of emergency department visits made by people living with chronic illness are unnecessary,
leading to $8.3 billion in additional costs to the healthcare market. The CCM program had such a positive
impact on patients, that CMS enhanced its Remote Care Management models to include Remote Patient
Monitoring (RPM) and Behavioral Health Integration (BHI) in 2018.

What is the difference between the Care Models?

Medicare patients with one chronic condition qualify for RPM, while patients with two or more chronic conditions qualify for CCM as well. Patients with either a mental health diagnosis or substance abuse diagnosis qualify for BHI. These chronically ill patients often need more attention and follow-up to ensure they are following their comprehensive care plan.
All three of these models are value-based care programs developed for Medicare beneficiaries who have chronic conditions and were developed to promote better healthcare through early intervention, reduce the burden of costly ER visits and hospital admissions, promote patient engagement in their care journey, and reduce overall care costs. NextGen Office Care Management Support Services enable your practice to provide higher-quality care while capturing more billable revenue. 

An overview of NextGen Office Care Management Support Services:

• We identify patients who meet CMS qualifications for each service. Patients may enroll in one or more of the services
depending on patient needs and provider approval. Our care team handles patient outreach and document consent to participate in the appropriate program(s).

• Dedicated nurse care managers:

- Reach out to qualified patients to communicate program value and reinforce care plans, freeing up physician and staff time

- Immediately triage patients with abnormal readings - Alert physicians of critical issues or patient compliance concerns for early intervention
- Ensure care plans are documented, sent to the patient, followed, and reviewed with the patient each month

- Provide a 24/7 dedicated telephone service for a line of communication with your patients when they need assistance

• No upfront or ongoing fees; the services are covered through the Medicare reimbursement of the services
rendered each month
• FDA-approved devices are provided for each patient who enrolls in RPM. This includes any associated medical supplies,
device setup and maintenance, and patient compliance.

• All documentation is transmitted into your NextGen Office system for provider intervention at the point of care

NextGen Office Care Management Support Services offers your practice end-to-end support for CCM, RPM, and BHI
services. This includes patient acquisition, care plan oversight, device management, triage of abnormal values,
and 24/7 access to our fully staffed team of nurse care managers, pharmacists, nutritionists, and social workers.

The value of our Care Management Support Services:

• Dedicated outreach promotes improved communication and participation in recommended care plans, keeping patient engagement high
• Supports disease control and health management goals through the implementation of comprehensive care plans
• Provides additional care for Medicare patients and helps avoid more costly emergency or hospital admissions
• Device management to promote patient engagement in continuous monitoring
• Increases provider visibility into a patient’s health status
• Increases access to patient-specific education
• Frees up the providers to focus on in-office encounters
• All charges and claims are submitted by you to ensure appropriate financial controls and tracking
• Reimburses your practice at an average of $62.00 per patient per month for CCM services, $94 for RPM, and
$48 for BHI services

As your EHR partner, NextGen Office Care Management Support Services is just one more way we can help you extend your care team, increase your revenue, and enhance patient engagement.