Chronic Care Management

The creation and revision of electronic care plans is also a key component of CCM so our CSP team members must establish, implement, revise, or monitor and manage an electronic care plan that addresses the physical, mental, cognitive, psychosocial, functional and environmental needs of the patient as well as maintain an inventory of resources and supports that the patient needs.

CMS states that patients must have “2 chronic continuous or episodic health conditions that are expected to last at least 12 months, or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.”

Comprehensive Care Plan – This is an electronic summary of the physical, mental, cognitive, psychosocial, functional, and environmental assessments, a record of all recommended preventive care services, medication reconciliation with review of adherence and potential interactions and oversight of patient self-management of medications, an inventory of clinicians, resources, and supports specific to the patients, including how the services of agencies or specialists unconnected to the designated physician’s practice will be coordinated. Including assurance of care appropriate for patient’s choices and values.

RXVIP Concierge adheres to CMS guidelines that allows clinical pharmacists, and “medical technical assistants” or CMAs) who are directly employed by the clinician (or the clinician’s practice) or a contracted third party and whose CCM services are generally supervised by the clinician, whether provided during or after hours. Thus the “incident to” rules do not necessarily require that the clinician be on the premises providing direct supervision.

RXVIP Concierge hires individuals to deliver CCM services that count the time towards the 20-minutes of non-face-to-face time, as the care must be “contact initiated.” This could be patient-doctor, patient-nurse, doctor-doctor, pharmacy-doctor, lab-doctor, or other contact regarding or by the patient via phone or electronic communication.

For example, if the CSP speaks with the patient about an adverse drug reaction (ie rash or other ADR) and then discusses that condition with the physician, who then prescribes another drug, then the time counts. If the office spends time running a report of all participants due for a flu shot or an A1C check, that time doesn’t count.

RXVIP Concierge utilizes Certified CCM technology, and documents the encounters to give appropriate CCM codes, to the physician for billing. RXVIP then compensates our CSP team members for their professional services