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*Assumptions:
- Their patient population meets the national averages for patient panel size, percent of patients with Medicare, percent of Medicare patients with chronic conditions, percent of Medicare patients with Medicare Advantage, and percent of Medicare patients with secondary insurance.
- 50% of eligible patients who have no out of pocket costs can be enrolled and 20% of eligible patients who would incur out of pocket costs can be enrolled.
- They hire 2 additional care management nurses to handle the additional workload and they purchase software to track which patients are eligible and to help them deliver the services efficiently.
- The practice seeks reimbursement for both CPT code 99490 (Chronic condition management) and CPT code 99091 (Collecting and interpreting patient data).