The Elephant in the Chronic Care Room

Since physician practices are now able to bill for services provided to qualified chronic care patients within their practices (both through Medicare as well as private insurance), there is an enormous opportunity for increased revenue. Providers spend large quantities of time treating chronic care patients and finally have a way to get paid something for the non-face-to-face services that were already being provided.

A large percentage of chronic care patients in any practice are on Medicare (where the threshold for allowable billing is only 20 minutes of non-face-to-face care per month). Most of these patients should be willing to sign the required consent form for this care and billing.

Now the elephant walks in. 

“All” that is needed, is to accurately log 20 minutes of time for each patient. But how can this time be recorded and documented?  If your staff spends time on the patient, it doesn’t always count.  If a patient calls to discuss a billing issue, you don’t get to bill for that. The staff must log the time for each action and document the services provided to ensure that billing is done correctly.

Next, someone must aggregate all of the time spent on each patient, remove any ineligible services, and bill for any patients where 20 minutes or more were expended. Expecting your staff to log these short timespans in the EMR often means that:

  • Unless it is a significant period of time, no one will log anything at all.
  • The doctor will rarely log any time.
  • There is no easy place to log anything on the EMR screens.
  • There is no way to get the information out of the EMR once entered.

This recording and tracking of time is the elephant that makes billing for chronic care such a difficult proposition. What can you do to tame the elephant?  There are several alternatives:

  • Create a spreadsheet to log all of the time spent. Each staff member must access the spreadsheet and log their time.
  • Log the times in the description field in the EMR and then write custom reports and interfaces for the EMR.
  • Wait for your EMR to support you.

None of these alternatives is acceptable.  If you try the spreadsheet approach, your staff will rebel. Trying to use the existing EMR capabilities is awkward and inconvenient. Waiting for the EMR vendor to support your needs may take a long time.

How can you solve this problem?  We created a set of services:

  • A screen extension that integrates with the EMR to track the time spent which requires only a few seconds to completely log each action.
  • Software that aggregates the time spent and generates reports indicating which patients are eligible for chronic care billing.
  • Use of Dulcian’s certified staff members who can perform these administrative tasks for you. You can assign routine tasks to us for completion and we will make sure that 100% of the time for those tasks is logged.
  • If your EMR supports a “Create Bill” interface, we can automatically generate the bill for you.

Taken together, these services will allow you to log nearly all activity associated with a patient.  If you are spending time on your chronic care patients, you should be compensated for it.


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