Where Quality & Compassion Matter

Professional Edge Nursing


Why are these Chronic Care Management Programs important to my practice?

CMS created the Chronic Care Management program in 2015 that would reimburse for Medicare patients that have multiple chronic conditions. It is an under-utilized program but when used has been shown to prevent hospitalization by 48%, 26% fewer hospitalized days, and 38% fewer ER visits. “The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals” (CMS Booklet, 2020).

The CCM program can help you to have up-to-date information on your patients which is always important but even more so with the Covid pandemic.

What is the cost for my practice to start the CCM program with Professional Edge Nursing?

There is no cost to you or your practice to utilize any of the Chronic Care Management Programs.

Is there a financial benefit for me to have Professional Edge Nursing be an extension of my practice?

Yes, when you contract with Professional Edge Nursing, you are agreeing to perform general supervision of your patients’ care plans for any CCM programs they agree to participate in. Professional Edge Nursing will bill directly to Medicare in which you will receive the full payment for the services, in turn Professional Edge Nursing will invoice you according to the signed contract. Your practice is never at any financial risk and because we are helping with patient compliance you have the potential to increase your STARS and HEDIS measures for the following year’s Medicare payment reimbursement.

What is the time commitment for the contract?

The contract has no end date, if for any reason either party chooses to withdraw from the signed contract, you will only need to submit in writing a 30-day notice of cancellation. This will allow for a final billing cycle.

How much time will I have to put into the CCM program?

With general supervision, you will customize the amount of time spent reviewing your patient’s care plans. You will also choose the easiest way to complete this, logging into Professional Edge Nursing’s CCM portal, having the Care Plans securely emailed to you, or faxed to your office. The only CMS mandate is that you or your medical team have a face-to-face visit with your patient 14 days after hospital discharge for the Transitional Program or within 7 days after hospital discharge for Complex Transitional Program. With either program, Professional Edge Nursing will assist in ensuring compliance with the programs.

How often will you contact the office?

Our communication with you or your assigned staff member will be tailored to your needs. You or your assigned staff have access to your patients through our portal and can always download the patients’ care plans. The Case Manager can email you or your assigned staff member to provide you with information regarding, any abnormal trends or remote monitoring readings, a need for refills, a difference in behavior, or any essential questions.

What if I want to access my patient’s information or a patient has questions?

You or your assigned office staff will have access to your patient’s information through our portal at any time day or night, as well as your patients that are enrolled have access to our 24/7 hotline at 800-382-3398.

Does it cost anything for my patients or practice to participate in any of the CCM programs Especially the Remote Monitoring Program and the use of the equipment?

The CCM program may have a cost of co-pays for your patients, however, Professional Edge Nursing will bill them directly for the co-pay.

As for the Remote Monitoring program, the co-pay may still apply however we cover the costs for the monitoring and the equipment. The patient will have to have cellular or wireless access so that the information can be transmitted into our software system.

Once I sign a contract how long will it take to have the Care Manager begin to contact my patients?

Set up will take 10-14 days, this includes EDI through CMS, information verification, and accessing your patient’s data. The data can be accessed directly through your EMR or through a CSV file to download into our software. After the patient is downloaded it will take 2 business days to contact your patient.

For additional questions please contact us.