Chronic Care Management requirements and benefits
Monthly reimbursement – One billing code
– Free, direct assistance with process
By TMF Quality Innovation Network
Did you know there is an easier way to treat patients with two or more chronic conditions and receive reimbursement for doing so? The Centers for Medicare and Medicaid Services introduced a non-visit-based payment code for Chronic Care Management, or CCM, services on January 1, 2015.
The billing code for CCM services is Current Procedural Terminology code 99490: “Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.” Practitioners offering CCM may bill Medicare every 30 days for non-face-to-face care coordination services. This CPT code pays approximately $42 per month, depending on regional differences in reimbursement amounts. Please type the following URL into your web browser to take you to the CCM webpage where you will find a revenue calculator that you can download and into which you can input your data and have it automatically estimate your reimbursement.
The TMF Quality Innovation Network Quality Improvement Organization has created an online Chronic Care Management Learning and Action Network to help physicians and clinicians successfully adopt CCM into their everyday workflow and processes. In addition, please type the following URL into your web browser to take you to the CCM webpage where you will find a useful CCM Process Checklist that you can download and use to guide you through the process and keep track of action items. It also includes links to other useful tools to complete specific process requirements.
Below is more information about what physicians and clinicians need to do to implement these services and be reimbursed.
Requirements
The following elements must be met for a physician or clinician to receive reimbursement.
- Patients have access to care management services 24/7
- Patients receive continuity of care so that they are able to get successive routine appointments with a designated provider or care team member
- Care management is provided for chronic conditions that include:
- Assessment of a patient’s medical, functional, and psychosocial needs through either an initial preventive physical exam or a comprehensive evaluation and management visit.
- Timely receipt of all recommended preventive care
- Patient’s medication is reconciled
- There is oversight of patient self-management of medication
- Development of a patient-centered care plan that includes the patient’s choices. The care plan is based on a physical, mental, cognitive, psychosocial, functional and environmental assessment. A copy of the care plan is provided to patients.
- Care transitions between providers and care settings is managed
- Services provided by home- and community-based clinical service providers is coordinated
- Patients and caregivers can communicate with the provider by phone or using other electronic methods for non-face-to-face consultation.
- The care plan is electronic and is available 24/7 to all providers furnishing care to the patient
Benefits
By working with the TMF QIN-QIO, physicians and clinicians can easily implement CCM services into their workflow. There is only one billing code, and the CPT code pays approximately $42 per month. The TMF QIN-QIO will provide the following additional benefits to physicians and clinicians who are members of the Chronic Care Management LAN:
- Assist clinicians by analyzing the characteristics of their Medicare FFS patients to determine which patients would be the most likely to benefit from CCM and document the frequency of CCM services in the patient’s care plan
- Assist practitioners to incorporate care plans into their electronic health record and billing systems
- Educate practitioners on setting up workflow processes, billing requirements, identifying clinical staff to deliver CCM services, enrolling patients in CCM EHR documentation, using telehealth and conducting educational webinars on CCM
- Identify and develop tools needed for practitioners to implement CCM information for patients such as: consent forms, care planning documents, comprehensive care plans, contact tracking logs to manage, track and document activities for patients who are receiving CCM services, and train practitioners and office staff on the use of this template.
- Provide access to a CCM webpage that contains useful links to resources, tools and educational events, including an online discussion forum for practitioners and other clinical staff interested in and/or implementing CCM.
- Provide practitioners with periodic reports tracking hospital admissions, readmissions and emergency department use for their patients enrolled in CCM
Join the Chronic Care Management Network
Additional information about the TMF QIN-QIO’s Chronic Care Management Program as well as free online tools, resources and upcoming educational events are available on the TMF QIN-QIO website. To join, go to www.tmfqin.org/ and locate Chronic Care Management under the Networks tab.