Chronic Care Management: New care coordination and revenue opportunities

Chronic Care Management: New care coordination and revenue opportunities

Last month, Medicare began paying qualified healthcare practitioners (namely, physicians, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives) and their practice entities a chronic care management (CCM) monthly fee to coordinate care for Medicare beneficiaries who have multiple chronic conditions.

The CCM policies provide new opportunities to furnish coordinated care while finding new sources of revenue for services that previously did not generate reimbursement. The 2015 Medicare Physician Fee Schedule Final Rule recognizes a new CPT code (99490) for CCM and establishes an average national payment amount of $40.39 per month.

Satisfying and documenting compliance with the requirements for CCM reimbursement will present compliance hurdles and related challenges. The Centers for Medicare & Medicaid Services (CMS) has established the following requirements for CCM services:

  1. The beneficiary must have at least two chronic conditions that (a) are expected to last at least 12 months or until death, and
    (b) create significant risk of death, acute exacerbation/decompensation, or functional decline;
  2. The practitioner must inform the beneficiary about the CCM services, obtain written consent, provide the beneficiary with a
    written or electronic copy of the care plan, and ensure that the beneficiary’s consent and receipt of the care plan are documented in the electronic health record (EHR);
  3. The practice must satisfy scope of service elements involving enhanced access, continuity of care, a plan of care, medication
    management, and communication with other healthcare professionals involved in treating the beneficiary;
  4. Clinical staff directed by a physician or other qualified practitioner must provide at least 20 minutes of CCM services for the
    beneficiary during the month; and
  5. The practice must use a certified EHR and capture plan of care information electronically.

For more information on CCM, see our recent alert "Medicare to pay for chronic care management."

CMS will hold a National Provider Call on February 18, 2015, from 1:30 to 3:00 pm EST regarding requirements for billing CCM services. For information and registration, go to: