Did You Know?
- One in four Americans have 2+ chronic conditions
- Seven of the top 10 causes of death in 2014 were from chronic diseases
- People with chronic conditions account for 84 percent of national healthcare spending
What is Chronic Care Management?
Chronic Care Management (CCM) services by a physician or non-physician practitioner (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, and/or Certified Nurse Midwife) and their clinical staff, per calendar month, for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until death, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
CCM Coding Summary-Effective January 1, 2017
- Initially adopted CPT code 99490 beginning January 1, 2015, to separately identify and value clinical staff time and other resources used in providing CCM
- Beginning January 1, 2017, CMS adopted three additional billing codes (G0506, CPT 99487, CPT 99489)
- Detailed guidance on CCM and related care management services for physicians available on the PFS web page
Key Changes for CY 2017
- Complex CCM service codes provide higher payment for complex patients, for whom the billing practitioner is addressing problems of moderate or high complexity during the month
- Patients who also require 60 or more minutes of clinical staff time and substantial care plan revision (or care plan establishment)
- Facilitated patient consent–Verbal rather than written consent allowed (must still be documented in the medical record)
- Initiating visit only required for new patients or those not seen within a year prior (rather than for all patients)
CCM for RHCs and FQHCs 2017
- RHCs and FQHCs can receive payment for CCM when CPT code 99490 is billed alone or with other payable services on an RHC or FQHC claim
- The RHC and FQHC face-to-face requirements are waived when CCM services are furnished to a RHC or FQHC patient
- Payment is based on the Medicare PFS national non-facility payment rate
- The rate is updated annually and has no geographic adjustment
- New Complex CCM Codes (CPT 99487 and 99489) and Initiating Visit Add-on (G0506)
- Payments for RHC and FQHC services are not adjusted for length or complexity of the visit
- RHCs and FQHCs are not authorized to bill these three new codes; therefore, these codes should not be billed by RHCs/FQHCs and would be subject to recoupment if paid
What is next with Medicare?
Medicare is launching a new campaign for Chronic Care Management.
The CMS Office of Minority Health (OMH) has been tasked under legislation to partner with the Federal Office of Rural Health Policy (FORHP) at the Health Resources and Services Administration (HRSA) to design and implement an education and outreach campaign to Inform professionals and consumers of the benefits of chronic care management services for individuals with chronic care needs. More details may be found in the provided links:
- The Health Care Professional Toolkit will be available for download mid-March at the following link: http://go.cms.gov/ccm
- Patient Educational Material; to order materials contact: CCM@cms.hhs.gov
Need Help with CCM?
CCM is a significant opportunity to earn reimbursement for care management services that help your patients, but the rules and regulations are complex. NextGen® Professional Services can help you to address the full CCM lifecycle within your practice workflow, maintain compliance with CMS rules, and build a program to support billing for CCM services. NextGen Healthcare also has partnered with CareSync, the leader in CCM. CareSync provides outsourced services that enable you to focus on patients while also generating additional revenue for your practice. To learn more, contact your NextGen Healthcare representative.