Driving Practice Revenue: Chronic Care Management

CMSBy now, most physicians are aware of the Medicare Chronic Care Management program that will pay them for non-face-time services for patients with two or more chronic conditions. Are you taking advantage of chronic care management billing? More than two thirds of Medicare beneficiaries have a chronic condition, so chances are your practice is eligible to participate if you accept Medicare. Many of these services are for routine care coordination that your practice likely already performs for patients, but historically hasn’t been reimbursed for. With the new program, CMS will pay approximately $42 for non-face-to-face chronic care management services, including ongoing development and revisions of care plans, communication with other treating providers, and medication management. There are a number of qualifications you will need to consider regarding CCM billing. These include:

  • Patients must have two or more chronic conditions that are expected to last at least 12 months or until the patient’s death and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  • To bill this code, physicians or their clinical staff members must spend at least 20 minutes performing the CCM services. Direct supervision is not required, which means that nursing staff or non-physician practitioners can render CCM even if the physician is not in the office.
  • Only one physician can bill CCM services for a patient and billing cannot occur more than once per month. There are also certain services that cannot be billed in the same month, including some home healthcare and transition care services.
  • Lastly, physicians must use EHR technology certified to either the 2011 or 2014 edition(s) of certification criteria.

To be expected, there are also a number of rules accompanying the opportunity for reimbursement:

  • Ongoing patient access to the practice. This includes access 24 hours a day, 7 days a week.
  • Continuity of care, which means that patients should be able to get successive routine appointments with a designated practitioner or member of the care team.
  • Systematic assessments of patients’ medical, functional, and psychological needs. This includes timely preventive care services, medication reconciliation, and oversight of patients’ ability to self-manage medications.
  • Creation of a patient-centered care plan document that serves as a comprehensive plan of care for all health issues.
  • Management of patients’ care transitions among providers and settings.
  • Enhanced opportunities for a beneficiary and/or caregiver to communicate with practitioners via phone, secure messaging, Internet, or other asynchronous methods.

If your practice is not currently billing for CCM services, you could be missing out on an opportunity to drive practice revenue. Take a moment to conduct and assessment of your patient base. Do you have critical mass? If the answer is yes, start implementing a CCM program today and reaping the revenue benefits.

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