In today’s rapidly evolving healthcare landscape, relying solely on your electronic health record (EHR) software and internal staff  to manage Centers for Medicare and Medicaid Services (CMS) reimbursable care coordination programs like Chronic Care Management (CCM), Principal Care Management (PCM), Behavioral Health Integration (BHI), Transitional Care Management (TCM), and Remote Physiological Monitoring (RPM) is a risky strategy. EHRs, while essential for clinical documentation, are not designed to provide the flexibility, agility, and specialized tools needed for effective care coordination outside the clinic. With staff shortages, access to networks of nurses and medical assistants trained in CMS care coordination introduces a valuable option.

What’s the Importance of Care Coordination?

The CMS CCM program plays a vital role in improving health outcomes for Medicare beneficiaries with multiple chronic conditions. By providing ongoing care coordination services, CCM helps patients manage complex health needs, enhances communication between providers, and reduces avoidable hospitalizations and emergency room visits.

Supporting programs like Principal Care Management (PCM) focus on patients with a single high-risk condition, offering targeted interventions to stabilize their health. Behavioral Health Integration (BHI) extends care coordination to include mental health services, addressing the critical interplay between physical and behavioral health for holistic patient care. Remote Physiological Monitoring (RPM) leverages technology to monitor patients’ health data in real time, enabling timely interventions and improving disease management for chronic conditions like hypertension and diabetes.

Together, these programs create a comprehensive framework that prioritizes preventative care, personalized attention, and proactive management of chronic and complex health conditions. By leveraging these CMS initiatives, healthcare organizations can improve patient outcomes, increase care quality, and enhance reimbursement opportunities, all while reducing overall healthcare cost

Keeping Up with Compliance

CMS updates its rules and requirements for these programs annually, requiring healthcare organizations to adapt quickly. Unfortunately, most EHRs lack the ability to keep up with these changes or to provide a comprehensive platform that supports all CMS reimbursable care coordination programs. Care coordination demands more than charting—it involves ongoing, compliant communication between nurses, medical assistants (MAs), and patients, often including social determinants of health providers who play a crucial role in supporting vulnerable populations, particularly the elderly.

While few like to admit this publicly, platforms purpose-built for care coordination, like CrossTx, excel where EHRs fall short. They are designed to handle secure and compliant patient-to-nurse communications and facilitate collaboration with community partners. These tools are essential for addressing the complex needs of patients in rural and frontier areas, where social and healthcare disparities are often pronounced.

EHRs Increasingly Hinder the Rural and Mid-sized Clinic

Large EHR providers, such as Cerner and Epic, have increasingly marketed their systems to mid-sized and large health systems, which then license access to smaller critical access hospitals and rural clinics. This arrangement often locks rural health organizations into rigid contracts with minimal leverage to customize their workflows or respond to unique community needs. Over-reliance on a centralized EHR system can stifle flexibility and patient engagement, creating a straitjacket effect that limits innovation and responsiveness.

Why Not Liberate, Improve Patient Care and Drive Greater Reimbursement?

Modern healthcare requires solutions that prioritize patient-centric care, interoperability, and adaptability. And particularly for the small to mid-sized clinic, the need for more reimbursement is constant.  Accessing CMS care coordination reimbursement streams becomes very useful today.

This need not be at the expense of more data entry.  Industry-standard APIs and modern integration tools make it seamless to connect specialized care coordination platforms such as CrossTx with existing EHRs, eliminating the need for dual data entry. Purpose-built platforms empower care teams to engage patients effectively and meet CMS compliance requirements without sacrificing flexibility or operational efficiency.

Highly Trained Staffing Key

 A majority of CCM programs fail to deliver promised reimbursement targets mostly because of EHR rigidities and a lack of staff to focus on the program.  Nurses employed by the clinic often must support multiple programs, diluting their utilization toward reimbursable activity.  CrossTx has evolved to help solve this dilemma. By providing the CCM platform along with highly trained nurses and MA as well as a care coordination communication center, small to mid-sized clinics, including rural and frontier, can now benefit with enterprise class systems via attractive partnering models. CrossTx launched Hyalite Care Academy as a platform to continuously train nurses, providers and even MAs to achieve CMS excellence.

Advance Care Coordination

By adopting a best-of-breed care coordination platform integrated with the EHR, healthcare organizations can avoid the pitfalls of EHR overdependence while enhancing patient engagement, improving outcomes, and maximizing reimbursement opportunities.

The future of healthcare demands tools that adapt to the unique needs of care teams, especially those working with vulnerable populations in complex care settings. Stay ahead of the curve  with a platform designed for care coordination success.

For more information contact CrossTx.