Chronic Care Invoicing Software

Invoicing in a Chronic Care Practice

Care management creates a new kind of patient balance: a small amount, every month, for a service the patient may not think of as a visit. Medicare pays its share of the CCM, APCM or remote monitoring claim. If the patient has Medigap, the coinsurance crosses over to that plan. What remains is the patient's share. Early in the year, more of it may go to the Part B deductible. Patients with QMB status owe nothing toward Medicare cost sharing, so they never get an invoice for it. Patients who declined consent can't be billed for the service at all. Chronic care invoicing software builds the patient invoice from what actually posted, not from what was charged. It combines the month's lines into one bill and names each service so the patient recognizes it, such as monthly care coordination calls or blood pressure monitoring. Patients can pay by card, set up a card on file, or call with questions.

Why Is Invoicing Different in Chronic Care?

Many patients forget they agreed to cost sharing. Consent may have been months ago, and the service happens on the phone. An invoice that just lists a CPT code and an amount leads to calls, disputes and requests to stop. Invoicing in chronic care has to explain the service in words the patient knows and point back to the program they joined.

Order matters. Medicare pays first, then Medigap or Medicaid, and only then does the patient owe anything. An invoice sent before the crossover posts may bill the patient for an amount the second plan was about to pay. A practice that invoices QMB patients for coinsurance breaks a federal rule, even if Medicaid paid less than the full amount.

Small monthly amounts also change the economics of collecting. Mailing a paper statement for a small balance every month can cost more than it brings in. Combining care management, remote monitoring and visit balances into one invoice, sent by text or email, keeps the cost down and the message clear. Patients on fixed incomes may also need a payment plan.

What Chronic Care Invoicing Software Handles

Part B cost sharing on care management

Patient cost sharing applies to CCM, and CMS notes that Medigap can help cover it. The invoice is built only after Medicare and any Medigap plan have paid, so the patient sees the true remaining share. (CMS MLN Booklet: Chronic Care Management Services (MLN909188))

No cost sharing for QMB patients

Federal law bars providers from billing QMB patients for Medicare deductibles, coinsurance or copays. QMB patients are kept off every patient invoicing run, and any balance left after Medicaid is handled by the practice's write-off policy. (CMS MLN Fact Sheet: Prohibition on Billing Qualified Medicare Beneficiaries (MLN7936176))

No billing without consent

If a patient declines CCM or never gives consent, CMS says the practitioner can't bill the patient for the service. Invoicing checks for consent on file before any care management line reaches a patient bill. (CMS: Frequently Asked Questions about Billing the Physician Fee Schedule for CCM Services)

APCM cost sharing

CMS tells practices to inform APCM patients that cost sharing may apply. The APCM month appears on the patient's invoice as one line, described as monthly primary care management, after any second plan pays. (CMS: Advanced Primary Care Management Services)

Stopping services ends the invoices

Patients can stop CCM at any time, effective at the end of the calendar month. Invoicing for the program stops after that month, and the final invoice notes the end date. (CMS MLN Booklet: Chronic Care Management Services (MLN909188))

How Does Chronic Care Invoicing Software Work?

1. 1. Wait for the remittances

   Invoices are built after Medicare's remittance and any crossover claim to Medigap or Medicaid have posted. Care management payment posting supplies the final amounts.

2. 2. Apply the patient protections

   QMB patients and patients without consent are kept off the run. Their balances go to staff for review instead.

3. 3. Combine the month

   CCM, APCM, remote monitoring and visit balances for the month are combined into one invoice. Each line is named in plain words the patient will recognize.

4. 4. Send and collect

   Invoices go out by text or email with a link to pay. Patients can pay by card or set up a card on file, and payments post straight back to the account.

5. 5. Answer questions

   Questions about the program go to the care team, and billing questions go to staff through chronic care patient billing. A request to stop the program is recorded and takes effect at month end.

Chronic Care Invoicing Software vs. Generic Software

Who Uses It in a Chronic Care Practice

• Billing staff: Invoices that wait for the crossover, skip QMB patients and explain each line, so fewer calls come back.
• Patient or caregiver: One clear bill a month that names the care they got, with an easy way to pay. Card payments land through care management integrated payments.
• Practice manager: Lower cost to collect small monthly balances, and fewer requests to stop the program over billing confusion.