After waiting a year to be able to participate in Medicare’s Chronic Care Management (CCM) program, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) still faced a formidable obstacle to implementing CCM.
In 2016, they could be reimbursed for providing CCM to their patients, but they were unable to contract with third parties to help them do so. Because CCM had to be provided by their clinical staff under direct supervision by the practitioner, offering CCM became challenging at best.
For most, the clinical staff was overwhelmed by trying to make time for CCM during regular office hours, practitioners were burdened with providing direct supervision after-hours, and many felt it was simply unrealistic to meet CCM requirements given their practice’s budget, human resources, and time constraints.
CMS Makes a Bold Move
Recognizing the need to not only remove obstacles to implementing CCM, but also ensure requirements for RHCs and FQHCs were "not more burdensome than those for practitioners billing under the PFS," the Centers for Medicare and Medicaid Services (CMS) made several changes to CCM requirements in 2017. Some changes were specifically beneficial to RHCs and FQHCs, while others were beneficial to practices in general. Changes included:
- Giving RHCs and FQHCs the ability to have general supervision of clinical staff, which allows them to contract with third parties (skilled care coordination companies) to deliver effective CCM programs and services on their behalf
- Instead of requiring 24/7 direct access to RHC and FQHC practitioners, requiring access to auxiliary personnel who have the means to contact those practitioners
- Requiring a face-to-visit with the patient to enroll them in CCM only if the patient is new or has not had a face-to-face encounter in the past 12 months
- Allowing patient consent to CCM enrollment to be verbal and documented in the patient’s record rather than requiring written, signed consent
Positioned for Success
With these changes in place, RHCs and FQHCs are now much better positioned to improve the overall health of their patients and generate new revenue for their practice through CPT code 99490 (RHCs and FQHCs are not yet able to participate in the complex CCM codes or add-on code G0506).
Choosing a CCM Partner
By choosing CareSync to deliver CCM services on their behalf, RHCs and FQHCs can benefit from the way CareSync:
- Exceeds Medicare’s requirements for CPT code 99490
- Helps remove the barriers to care many patients face, such as prescription costs and transportation concerns
- Achieves an industry-leading low churn rate and high billable rate
- Offers enrollment and monthly billing support, as well as best practices for success
- Offers both full-service CCM and a software-only option
The Bottom Line
Given the ability to contract with a third party, RHCs and FQHCs no longer have to miss out on the valuable outcomes and revenue associated with CCM. CareSync has the infrastructure already in place to support your efforts. Ask us for a demonstration today!