Setup is Quick
A week after enrollment, the patient gets his or her first phone call from the Chronic Care Coordinator.
Together, they review the care plan, establish an ongoing call schedule and get the patient set up in the optional patient portal.
For your patient, CCM quickly becomes a consistent part of the health care delivered by your practice.
The Evolution of CCM
CMS regulation of chronic care management continues to evolve since its introduction in January 2015. These are some of the changes that CCM has already undergone:
While they were not permitted to bill for CCM in 2015, Rural Health Clinics will become eligible to bill for CPT code 99490 starting in January 2016. This is an indication of how the population covered by CCM is expanding.
Remote monitoring can count toward the time per month for CCM, but it cannot be the exclusive source of care management. As wearables and other technologies become more popular and affordable, this will be more prevalent.
What Services Are Included in CCM?
CMS specifies that CPT code 99490 may be used to bill for “non-face-to-face time follow-up care outside of the office.” There must be at least 20 minutes per month of non-face-time follow-up care provided to eligible Medicare patients outside of the office each month, including such activities as:
• Discussing the care plan with the patient
• Reviewing medications and therapies
• Scheduling phone-based and other non-office encounters
• Reviewing labs and testing with patients
• Scheduling referrals and coordinating all care
• Coordinating documentation from other doctor offices so that you have all the information you need
The average reimbursement for 99490 is $43 per patient per month. If in each month, a patient is both seen at the office and receives non-face-to-face care management, both incidents are billable that month. There are services for which a provider is not allowed to bill during the same calendar month as CCM. These include:
• Transitional care management (CPT 99495 and 99496)
• Home healthcare supervision (HCPCS G0181)
• Hospice care supervision (HCPCS G0182)
• Certain end-stage renal disease (ESRD) services (CPT 90951- 90970)
How Does CCM Benefit Patients?
• As a patient-engagement program, CCM builds “buy-in” with patients. The program and its various services enhance shared decision-making between the physician and patient around their health issues.
• In addition, since monthly phone
How Does CCM Benefit Physicians?
• Financial incentives for enrolling patients in CCM mean that practices are now compensated for time and care that they were previously delivering for free. Depending upon the number of eligible patients enrolled, CCM revenue can be a significant incremental revenue stream for a practice.
• Monthly CCM calls also tend to reduce the number of calls coming into the office from patients each day; such inbound calls related to acute issues to nursing and other staff are not eligible for
• Finally, CCM facilitates the transition to outcome-based compensation, the standard the CMS wants to apply in the near future. The time is coming when physicians will be reimbursed at a higher rate when they can demonstrate fewer patient hospitalizations, lower cost of care, more positive outcomes and greater patient satisfaction. CCM systems help a provider demonstrate outcomes.
Recent Blogs and Articles
Centers for Medicare and Medicaid Services (CMS) has recently released the final ruling for this year's Medicare physician fee schedule. These changes include some exciting new regulations and rules for chronic care management. One change will be new principal...
Today let’s look at communication between nurses and doctors. Communication is key when dealing with chronic care management. When communication is not key, disconnects can occur from simple misinterpretations, which can result in incorrect...
In part 1 & 2 of this series we defined the criteria for patients’ qualification for Chronic Care Management. We’ve also identified three subsections of patient needs in Chronic Care Management. In this installment, let’s look at one more Highest Risk...
In part 1 of "How To Qualify Your Patients For CCM," we defined the eligibility of the patient for such a program, and we determined that the highest risk patient would be the one who was recently hospitalized or is regularly in the ER. With this installment,...
Let’s take a look at how you might go about managing your chronic care patients. How do you add Chronic Care Management to your menu of services already underway in your practice? You’re looking at the vast number of patients in your current practice, and...
To continue our series of “Tough Questions” we created a situation with a theoretical patient in which posed us with the ethical dilemma of determining whether the patient was going to be able to continue with their chronic care management program. This patient had...