Shield Health - Managing Medicare Patients

HOW THE PROGRAM WORKS

Qualify Patients

Medicare patients with two or more chronic conditions are eligible for program

Enroll Patients

Patients can enroll online, over the phone, or in the office with the help of Shield Health nurses

Engage Patients

Shield Health nurses call, text, and email patients throughout the month to discuss healthcare plans, goals, and issues

Review Care Monthly

Provider reviews and signs patient care plans once a month provided by Shield Health

Bill & Collect

Practice bills relevant Medicare Chronic Care Management codes once a month. Practice collects and pays Shield Health fee.

FREQUENTLY ASKED QUESTIONS

What is Chronic Care Management (CCM)?

Chronic care management (CCM) is a Medicare Fee for Service (FFS) program that allows providers to manage and coordinate care for patients with two or more chronic conditions in between in-office visits.

What conditions qualify for CCM?

CMS defines a chronic condition as “conditions expected to last at least 12 months or until the patient’s death and or that place them at significant risk of death, acute exacerbation and or decompensation, or functional decline.” This includes but is not limited to Alcohol Abuse, Drug Abuse/ Substance Abuse, Alzheimer’s Disease and Related Dementia, Heart Failure, Arthritis (Osteoarthritis and Rheumatoid), Hepatitis (Chronic Viral B & C), Asthma HIV/AIDS, Atrial Fibrillation, Hyperlipidemia (High cholesterol), Autism Spectrum Disorders, Hypertension (High blood pressure), Cancer (Breast, Colorectal, Lung, and Prostate), Ischemic Heart Disease, Chronic Kidney Disease , Osteoporosis, Chronic Obstructive Pulmonary Disease, Schizophrenia and Other Psychotic Disorders, Depression, Stroke, and Diabetes

Which patients are eligible for CCM?

Medicare patients with two or more chronic conditions who are not already enrolled in another CCM program qualify.

What are the expenses to the practice?

No capital is required from the practice at any time during the life of the program. The only expense incurred by the practice is the physician's time to review and sign care plans as well as the administrative team's time to bill and collect.

How does the program generate revenue?

All Shield Health services meet CMS's requirements for Chronic Care Management. Physicians can expect approximately $600 in annual profits to the practice per patient enrolled.

Can a specialist bill for CCM?

Yes. Except for limited-license physicians and practitioners, CMS allows all billing providers - including NPs and PAs - to furnish CCM services.

ABOUT US

Our team built Shield Health to support physicians and improve patient health. Our goal is to encourage and educate patients with high-touch, intimate virtual care, allowing physicians the time they need to focus on more acute details in the practice. The Shield Health team is driven by the notion that simple, clear information can affect change, and that small, consistent changes over time have profound impacts on patients. Shield Health seeks to create that change one touch - one activity - one patient - one day at a time.

CONTACT US