Patient Care Management

Medi-Code automates the workflow or process of Patient Centric Medical Home (PCMH) which allows the practices to support patient health maintenance via remote and home monitoring of patients for vitals and medication use. Based on clinical metrics it allows risk reporting of patients so that the care coordinators can take appropriate actions.  Care coordinators plan the proactive care of the patient based on the risk profile generated by Medi-Code.  Medi-Code integrates with home monitoring devices to ensure automatic alerts to the care coordinators and notifications to the physician as needed.

This year, CMS launched a new 99490 reimbursement code for Chronic Care Management (CCM).  Research consistently shows that effective chronic care management reduces the costs of care for chronic care patients while improving their overall health.  Now each month you provide these services to your patients you can be reimbursed.  CPT 99490 pays about $42 each month you provide at least 20 minutes non-face-to-face chronic care coordination for your Medicare (and certain other insurers) patients who have at least two chronic conditions.  About 2/3 of Medicare patients have two or more chronic conditions, e.g. diabetes, morbid obesity, hypertension, or Alzheimer’s.  Medi-Code has launched a new service that will allow your practice to access this new revenue source.  When you partner with Medi-Code, you earn additional money while you improve patient care without disrupting your staff or changing your workflow.  And you don’t need to invest any money.

Medi-Code supports Population Management in the following ways

  • Provide a complete Chronic Care Management Solution
  • Provide qualified Care Coordinators
  • Provide all the information needed for the CCM billing
  • Let practices continue to do what they do, while complying with CMS and HIPAA requirements
  • Figure out Medical Home PCP for each patient and provides notification to both patients and physicians
  • Identification of  the high risk patients for each clinical measure –  using the EHR data
  • Identification of the  high cost patients from cost utilization per patient per TIN – using the claims data
  • Reporting by each cost categories: Admits, Discharges, ER Visits, Ancillary usage (MRI, CT), etc.
  • Reporting by Provider, by TIN as well as for the entire ACO – to identify the cost drivers
  • Real time reporting of care coordination, transitional care, and case management data

Patient Surveys (CAHPS) reporting  are made available to internal management of the ACO

Care Management

    • PCMH process allows proactive care for High Risk, High Cost patients.
    • Helps prevent high cost events such as hospitalizations, readmissions and ER visits.
    • Disease management including medication compliance.
    • Case management incl-uding home monitoring.
    • Sharing of real time data across EHRs and outside providers helps with better care at lower costs.
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Patient remote and continuous monitoring

Care-Management-dashboard

Medi-Code provides a 24/7 patient monitoring solution that the provider networks or the ACOs can leverage to support care management activities. Through this proactive monitoring capability it is possible to reduce ER visits and help lower costs for the network.

 

Some of the monitoring features include:

Automated Alerts and Reminders: To avoid unnecessary calls sent to the patients by care coordinators our system dials from a list of “at risk” patients and plays a pre-recorded message either to an individual or to an answering machine. A medical staff member is not involved. This is used to remind patients of appointments, medication, questionnaires, vitals and daily activities.

Alerts & Reminders
Vital Signs Monitoring

Vital Signs Monitoring:  To support remote monitoring it is possible to set up vital sign parameters based upon the patient’s history, current assessment and physician’s orders and assign schedules and reminders  for the patient to record their vital signs. If the recording is outside the parameters the care coordinator can contact the patient and also inform the physicians for appropriate action.

Continuous Remote Monitoring:  Medi-Code offers easy-to-use, mobile monitoring solutions enabling effortless and continuous remote monitoring from anywhere at any time. Our cellular-based mobile monitoring and communication devices can seamlessly transmit real-time data, such as medical information, environmental data, location or distress alarm to a remote medical center for online monitoring and advice. Our solutions are intended for tele-health, tele-care, medical alert and tele-assistance applications, enabling users to be monitored continuously and effortlessly from anywhere, at anytime.

Continuous Remote Monitoring-1
Video Conferencing

Video Conferencing:  Medical video conferencing solutions from Medi-Code enable patients and physicians to meet for consultations from wherever they may be without the need for travel. With HD video, physicians can be virtually connected with patients, using technology to look into an ear canal, view an X-ray or fully examine a patient to provide a diagnosis in real time from a computer, tablet or even a mobile device.