Case study on: eCareMD Enhancing Neurological Care in a Pain Management Group with PCM

Client Overview:

The client has a pain management and neurology clinic in New York. The specialist provider group of pain management handles complex cases such as fibromyalgia, migraine, and neurogenic pain with the goal of improving longitudinal tracking and ensuring CMS-compliant billing through PCM. Targeting their care requires patients to provide PCM care services for conditions that need pain management and constant care.

Business Challenges:

In PCM care management services, the care team members need to identify ongoing problems and oversee the patient’s health outcomes. At the time of providing these services, the client had an absence of a system to track the earliest symptoms and planned interventions accordingly, improper documentation of consents, a lack of provider-level tasks, and insufficient quality audit reports. Because of these missing workflows in day-to-day operations, the client’s business is having trouble achieving its revenue goals. Some of these challenges are highlighted below:

1. No formal mechanism for tracking long-term symptoms and interventions:

Identifying and tracking symptoms as early would be helpful for care team members to tackle conditions to reach health outcomes, as in neurological pain management, the symptoms, such as chronic migraines, neuropathic pain, and muscle spasms, can develop over a month. In such situations, the client-provider team has no formal mechanism for tracking these symptoms and preparing related interventions, which can cause a significant health risk. This leads to missing the opportunity to identify symptoms and prepare an action plan at the early stages.

2. Verbal consent was taken but not documented for PCM billing:

In PCM billing, documented consent plays a crucial role, especially in verbal or written form. Currently, the client’s clinic is not maintaining any structured way to document and store the obtained consent, which leads to a risk of not maintaining the PCM consent compliance and increases the frequency of claim denials.

3. Follow-ups missed due to unassigned care management tasks:

While providing PCM care, the missed care team tasks are delaying patients' follow-ups, as the client has no internal systems to assign tasks between care team members, resulting in increased ignorance in follow-ups.

4. Difficulty generating reports for audit and reimbursement:

The structured reports of the audit are key to the reimbursement process. The clinic currently lacks centralized, automated reports, and has difficulty generating these reports in the current traditional method, which is troubling for clients to manage the monthly audit process. Without these standardized reports, care services are failing to reach reimbursement for their monthly billing targets.

Solution Provided:

To tackle these issues, the Client has researched several options for care management software from which they interact with Medarch Inc., which has a top-trading care management software product. The business understanding has been established from Medarch’s business analyst team the key solutions were implemented for PCM Care services in the form of eCareMD Care Coordinator Software. The solutions were implemented as follows:

1. Care plan builder with symptoms and care plan tracking:

As soon as the client's business adopted the care management services with the help of eCareMD software, the major enhancements filled the gap to track the earliest symptoms by its in-built care plans creation module for patients. The library section has the flexibility to create and edit predefined care plan templates, which focus on symptom finding and more on care plan tracking over data addition, such as ongoing symptoms and interventions. These help when the care team member assigns a care plan and creates an action plan by concluding the interventions to tackle chronic diseases.

2. Bulk and individual PCM consent workflows, including verbal/written/digital:

For the PCM program, the consent plays a very important role in the enrollment process, while eCareMD provided the feasibility to obtain program consent in verbal, written, and digital, which provides a seamless workflow and standardizes documentations. The provider is managing their consent to maintain compliance, having consent on time for enrollment individually and in bulk.

3. Team-based task coordination improved patient retention:

The eCareMD provides role-based access for the providers, from which providers can assign, track, and manage tasks for other care team members. This cooperative workflow helps care providers to work collaboratively to improve patient health outcomes, leading to patient satisfaction with care management services.

4. Automated billing and clinical report generating:

While observing the absence of standardized reports in the current process, the eCareMD has an automated system to generate billing reports with information such as a Patient list with qualified CPT codes with respect to care manager and physician log time, and clinical report including care plan updates, vital data and provider review status. These reports are used to maintain CMS’s guidelines for the audit and reimbursement process.

Value Added:

1. PCM billing improved from Random to 95%+ compliance:

With the use of eCareMD’s standardized reports, the client’s business has successfully maintained 95%+ compliance under CMS’s PCM billing. This improved the value of the client's business in the healthcare industry.

2. Over 400+ PCM Patients reimbursement within 60 days:

The automated process has impacted the client’s business to improve areas like patient enrollment, care management, and reimbursement process, resulting in growth in revenue generation of over 400 PCM Patients per month within 60 days of the period in the PCM program.

3. Documentation errors dropped by 75%:

With the help of an accurate documentation process in audit, consents, and reports, the client’s provider team has maintained consistency in documentation while working collaboratively, which drops the error rate in documentation by 75% to the traditional workflow.

4. Boosted Client confidence in PCM care management and revenue success:

While providing neurological care in PCM care management, the help of eCareMD streamlines the day-to-day workflow, boosting clients’ confidence to do quality business in PCM care management.