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Our transformative approach to acute care brings hospital-level services to patients' homes and senior living facilities, prioritizing convenience, comfort, and safety. By focusing on Transition and Chronic Care Management and incorporating Remote Patient Monitoring, our Hospital at Home feature accelerates recovery, enhances patient outcomes, and ensures comprehensive care in familiar surroundings.
Streamline Caregiving
Our patient care approach includes personalized goal setting, patient education, and comprehensive service tracking and reporting. This ensures individualized care plans and continuous evaluation to improve patient outcomes and satisfaction.
Continual Patient Monitoring
We capture, visualize, and interpret patient data to inform complex care decisions, ensuring informed and effective treatment plans. Additionally, we prioritize patient education, delivering accessible and comprehensible information to empower patients in their healthcare journey.
Care Team Coordination
Assign patient care tasks to clinical team members using task lists for greater clinical efficiency. Management can then monitor care performance and document calls with patients to support workflow, ensuring all members of the care team are informed and coordinated.
Analytics
Our platform simplifies access to comprehensive patient billing summaries and reports, ensuring accurate billing for efficient reimbursement and financial management. Its user-friendly interface allows providers to easily navigate and review billing data, optimizing practice efficiency and revenue.
Transitional Care Management
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Transitional Care Management (TCM) offers patients services during the crucial 30-day period following discharge from specific healthcare settings.
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TCM ensures continuous care for patients, aiming to prevent gaps in care and readmissions.
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Key features include tracking patient transitions, documenting calls with patients to facilitate workflow and keep the care team informed, and capturing medication details to enhance patient engagement in adherence.
TCM
Moderate Complexity: 99495 (within 14 days of discharge).
High Complexity: 99496 (within 7 days of discharge).
CCM
Complex: 99205 (High Complexity Initial Assessment) and 99204 (Moderate Complexity Initial Assessment) performed by Physician.
99487 (60 minutes) and 99489 (30 additional minutes), performed by clinical staff.
Non-Complex: 99202 (Straightforward Initial Assessment) and 99203 (Low Complexity Initial Assessment) performed by Physician.
99490 (20 minutes) and 99439 (20 additional minutes), performed by clinical staff.
99491 (30 minutes) and 99437 (additional 30 minutes) performed by Physician.
*G0506 is an add-on code for all Initial Assessment codes.
PCM
Performed by clinical staff: 99426 (30 minutes) and 99427 (additional 30 minutes).
Principal and Chronic Care Management
Principal Care Management (PCM) offers comprehensive services to patients with 1 chronic condition. It requires a minimum of three months, and its goal is to stabilize the patient so they can be retransferred to the primary care provider. Its maximum expected duration lasts about a year.
Chronic Care Management (CCM) offers comprehensive services to patients with 2 or more chronic conditions. CCM is adaptable for years of implementation and requires a minimum duration of 12 months for chronic conditions. The goal of CCM is to work alongside primary care providers.
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It facilitates patient enrollment, engagement, and personalized care planning while tracking and reporting billable services under Medicare.
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Clinicians use task lists for enhanced clinical efficiency, while management can monitor care performance.
Remote Patient Monitoring
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Remote Patient Monitoring enables the management of conditions through continuous patient data capture.
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It allows providers to set parameters for measurements and readings, offering proactive attention to patients' conditions to prevent hospitalizations or readmissions.
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Documentation of notes, goals, and next steps is facilitated within a software solution.
