For most of us, turning 65 and becoming a “Medicare Patient” is a bit of a wakeup call. Youth won’t bail us out anymore. We have to actually work at maintaining our physical condition. We need more than occasional acute care from our primary care physicians and other providers. We may have to ask for more help with challenges of daily living from our families’ and social networks. We have left the old familiar domain of private insurance and have entered into the Medicare beneficiary labyrinth.

It doesn’t take long to figure out we don’t know what we don’t know, and we are paying the price in dollars and in time.

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In the past, Primary Care Physicians and Staff have, without compensation, stepped up to help seniors with these issues on an ad hoc basis. Now, the financial and practice time burden on the traditionally staffed practice is too great. And, the “catch as catch can” approach is not able to truly satisfy patient demand.

The good news today: To their great credit, Medicare has recognized some of these senior needs and has established a CPT code (99490) that addresses and pays for one category of services senior patients need, Chronic Care Management.

Some of the remaining challenges:

• It doesn’t cover all seniors. For those it covers, it doesn’t pay for all the services they need.
• Delivering CCM services and getting paid requires a records system that documents service activity times. Code 99490 pays $42 for 20 minutes per calendar month. Medicare pays 80% ($34). Seniors will be billed for 20% co-insurance ($8)
• No service minutes above or below 20 minutes in a calendar month are billable, and they do not carry over or accrue into the next month.
• Seniors have to consent in writing to be billed for these services. They can withdraw at any time.

RPCSolutions has developed a practice membership program model call RPCSeniorline™ that “wraps around” the Medicare CCM program. It covers all seniors in the practice (not just those that qualify for 99490 services), and offers all the services seniors may need, not just those covered by the 99490 code.

RPCSolutions has partnered with MDCommerce to deliver this program to independent primary care physicians (fee-for-service or hybrid concierge) on a completely turnkey basis i.e. fully staffed, together with all applications and systems necessary to carry on the work and integrate into the daily life of the practice.

A prototypical practice (400 seniors, 300 of whom qualify for CCM 99490 services) can expect to generate revenue of something over $80,000 a year, and net about $50,000 free and clear of all expenses, including MDC, RPC and Practice program delivery costs.