Chronic Care Management: Don’t Leave Money on the Table!

This article gives providers the information they need to take advantage of CPT 99490 reimbursement for chronic care management (CCM).

 

Managing patients with two or more chronic conditions could provide additional revenue to your practice to cover the cost of that care. Here’s what you should know.

 

How is Chronic Care Management defined?

On January 1, 2015, Medicare began reimbursing providers delivering 20 minutes or more of non-face-to-face time per calendar month managing these patients.  Time spent providing the service may be provided by different clinical staff on different days, but must total 20 or minutes in one calendar month.

 

Who can bill for Chronic Care Management?

Centers for Medicare and Medicaid Services (CMS) will pay eligible providers – primary care physicians, some specialists, nurse practitioners, and physician assistants – an average of $41.92 per month per eligible beneficiary.  It is important to note that deductible and co-insurance amounts do apply to this service.

 

What are the patient requirements?

To be eligible for Chronic Care Management (CCM) billing, a patient must have two or more chronic conditions expected to last at least twelve months. To ensure only one provider bills for a patient’s CCM service, you must obtain the patient’s written consent authorizing you to:

• Bill for CCM services; and
• Share data with other providers.

 

What scope of services is involved in Chronic Care Management?

A team approach to the continuity of care is generally used, including provider, nurse, or other clinical staff.  Patients or caregivers must be able to communicate with team members either by phone, secure messaging, secure internet, or other methods that comply with the Health Insurance Portability and Accountability Act (HIPAA).

 

Access to care management services must be available 24 hours a day, seven days a week.  The plan must be available for healthcare practitioners in the practice to provide timely response to address the patient’s urgent chronic care needs.

 

A patient-centered care plan based on physical, mental, cognitive, psychosocial, functional, and environmental assessment with an inventory of resources is required for each beneficiary.

 

This care plan must be in electronic format and available to share outside the practice as appropriate.  The patient must also be given an electronic or written copy of the care plan.

 

CMS requires the use of a certified Electronic Health Record (EHR) to satisfy some of the scope of service elements.  For reimbursement in calendar year 2015, the EHR must be certified to either the 2011 or 2014 editions.

 

Scope of Service Elements include:

• Structured recording of patient health information with certified EHR
• 24/7 access to care management services
• Electronic care plan addressing all health issues
• Managing care transitions
• Coordinating and sharing patient information with practitioners outside the practice

 

What are the billing requirements?

The requirements for billing CCM services are extensive, but many practices already provide most of these elements. With a few modifications, most practices can realize a financial return on the investment.