Looking for an update on Chronic Care Management in 2017? CareSync CEO Travis Bond provides information about this healthcare program to help healthcare providers improve patient health, maximize Medicare reimbursements, improve the doctor - patient relationship, and navigate value-based transformation in healthcare.
When the Centers for Medicare and Medicaid Services (CMS) expanded the CCM program at the beginning of this year, the changes they made addressed many of the concerns healthcare providers had been expressing about the program and its reimbursement structure.
- The Centers for Medicare and Medicaid Services introduced additional codes that supported complex Chronic Care Management cases and offered higher reimbursements in general. This made implementation far more attractive and profitable.
- CMS eased certain restrictions that dramatically simplified the enrollment process. Patients can now give verbal consent to CCM enrollment rather than written consent, as long as their decision is documented in their patient record.
- The requirement that patients be enrolled in CCM during a face-to-face qualifying visit is now only applicable if the patient is new or has not had a face-to-face encounter in the past 12 months. Otherwise, the patient can be enrolled by phone.
- CMS established an add-on code that supports the extra time physicians take in person to create a comprehensive care plan and initiate CCM services, time that would not have been part of the typical office visit. This initiating visit is not part of the CCM service and is separately billed.
- CMS made changes to CCM requirements as they apply to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), giving them the ability to have general supervision of clinical staff rather than direct supervision. This allows them to now contract with third parties to deliver effective CCM programs and services on their behalf under the original non-complex CCM code (RHCs and FQHCs are not able to participate in the new complex CCM codes or add-on code).
- CMS also changed the requirement that CCM patients have 24/7 direct access to RHC and FQHC practitioners. Instead, the requirement is now 24/7 access to auxiliary personnel who have the means to contact those practitioners.
Have You Maximized Chronic Care Management in 2017 Yet?
CCM services are typically provided outside of face-to-face patient visits and focus on characteristics of advanced primary care such as:
- A continuous relationship with a designated member of the care team
- Patient support for chronic diseases to achieve health goals
- 24/7 patient access to care and health information
- Receipt of preventive care
- Patient and caregiver engagement
- Timely sharing and use of health information
Physicians can contract with third parties who will deliver effective Chronic Care Management programs and services on their behalf in 2017 or beyond, while following the physician’s preferences and protocols. This can improve the overall health of their patients, while generating new revenue for their practice.
Today, Medicare’s CCM program consists of the following codes: CPT 99490, CPT 99487, CPT 99489, and add-on code G0506.
CPT Code 99490 and Chronic Care Management in 2017
Also now referred to as non-complex CCM, CPT 99490 reimburses physicians for providing at least 20 minutes of non-face-to-face care coordination to eligible Medicare beneficiaries with two or more chronic conditions. These chronic conditions are expected to last at least 12 months or until the death of the patient, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Although CMS maintains a Chronic Condition Warehouse with common chronic conditions listed to provide beneficiary, claims, and assessment data, it did not limit the chronic conditions allowable under the CCM program. Instead, chronic condition status is left to the discernment of the provider.
With CPT 99490, a comprehensive care plan is to be established, implemented, revised, or monitored. And clinical staff time is to be directed by a physician or other qualified healthcare professional, per calendar month.
CMS increased the reimbursement for CPT 99490 by about 5% this year to an average of $43 per patient per month.
Complex Chronic Care Management Codes
In the first two years of the CCM program, it became clear that for some patients, CCM requires additional care coordination time and more complex medical decision-making that many felt was not covered by reimbursement through CPT 99490. CMS addressed this by implementing separate payment for Complex Chronic Care Management using CPT codes 99487 and 99489.
CPT 99487 reimburses approximately $94 for 60 minutes of non-face-to-face care coordination and CPT 99489 reimburses approximately $47 for each additional 30 minutes (CPT 99489 can only be reported in conjunction with CPT 99487).
Add-On Code for Chronic Care Management Enrollment
Add-on code G0506 reimburses providers for the extra time it takes to create a comprehensive care plan and initiate CCM services, time that wouldn’t have been part of the typical office visit.
The code is for practitioners who furnish a CCM initiating visit and personally perform extensive assessment and CCM care planning outside of the usual effort described by the initiating visit code.
The average reimbursement rate is $64 for this one-time code and must take place during the initiation of CCM services.
New Chronic Care Management in 2017 White Paper Available
To learn more about Chronic Care Management in 2017 (and beyond) and its value to patients and practices, download a free copy of our all new CCM white paper, “Chronic Care Management: Improve Patient Health, Increase Practice Revenue.”