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Remote Extended Care Management

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Enhancing Patient Attribution Through Chronic Care Management and Annual Wellness Visits

ACOs play a big role in modern healthcare, encouraging practices to provide top-notch care while being mindful of costs. By focusing on services that Medicare values, like AWVs and CCM, your practice can improve its financial health and contribute to a healthier patient community.

Remember, providing great care is not just about the money – it’s about making a positive impact on your patients’ lives.

The Role of Chronic Care Management (CCM) and Annual Wellness Visits (AWV) in Patient Attribution

Chronic Care Management (CCM) services and Annual Wellness Visits (AWV) play pivotal roles in the process of patient attribution, significantly influencing the operational success of Accountable Care Organizations (ACOs).

CCM encounters are particularly valuable due to their regularity, providing monthly touchpoints with the patient. This frequency ensures a continuous engagement with the patient's health management. On the other hand, AWVs stand out as critical preventive care encounters, emphasizing the importance of preventative health measures in patient care strategies.

CCM's Impact on Patient Attribution

Enrollment in a CCM program such as the one Remote Care Today offers, guarantees a patient receives monthly care management interactions, amounting to twelve encounters annually. These encounters are documented through specific Current Procedural Terminology (CPT) codes, including:

  • 99487

  • 99489

  • 99490

  • 99491

  • 99439

  • 99437

The consistent billing of these codes for a patient across a year, signals to an ACO that your practice has provided the majority of care for the patient, leading to patient attribution to your facility.

AWV's Contribution to Patient Attribution

These visits are designed to be patient-centric, eliminating copays and promoting essential health screenings and vaccinations. However, it's crucial to note that a patient is eligible for only one AWV per year, underscoring the importance of eligibility verification systems to prevent duplicate claims and ensure appropriate patient attribution.

Strategic Implications of CCM and AWV in Patient Attribution

Given the variety of patient attribution models across different ACO frameworks, there is no absolute certainty in attributing a patient to a specific practice. Nonetheless, enhancing your patient attribution rate remains a critical goal for the financial viability and clinical effectiveness of your practice.

The integration of AWVs and CCM into your healthcare offerings not only improves patient health outcomes but also significantly boosts the likelihood of patient attribution to your practice. This strategy leads to increased revenue and strengthens your practice's position within its ACO by demonstrating a commitment to preventive care and patient management.

The strategic implementation of CCM and AWV programs is instrumental in improving patient attribution rates, thereby enhancing the operational success of practices within ACOs. These programs underscore the value of preventive care and consistent patient engagement in achieving positive health outcomes and financial stability. For practices interested in expanding their preventive care services, comprehensive guides on CCM and AWV offer valuable resources for understanding and navigating these complex yet rewarding areas.


By prioritizing these programs, your practice can effectively increase its contribution to the ACO's success, ensuring both enhanced patient care and financial rewards. Remote Care Today provides a turnkey solution for these programs. No extra staff, no upfront cost, and increase revenue. Reach out for a call to learn more!

Remember, providing great care is not just about the money – it’s about making a positive impact on your patients’ lives.

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