How to Get Paid for the New Chronic Care Management Code. White Paper. How to Increase Your Practice Revenue Without Seeing More Patients

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1 How to Get Paid for the New Chronic Care Management Code OR How to Increase Your Practice Revenue Without Seeing More Patients

2 Under a new chronic care management program authorized by CMS and taking effect in 2015, you can bill $42.60 per 30-day period for 20 minutes of chronic care activity (nonencounter based follow up care). Did You Know? Annually, this can add up to a good sum: $ per year per patient * X 100 patients $51,120 per year Many of your senior patients likely have two or more chronic conditions, and you are probably already doing this type of care management for your patients with chronic conditions. The good news is that now you can get paid for it. *Assumes you bill 12 months out of the year

3 How to Start Identify fee-for-service Medicare patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline. Inform the patient that you will be providing them with this service and obtain their signed permission on an agreement that you make part of the medical record.

4 Provide 20 minutes or more of chronic care management services per patient per 30 days. The 20 minutes cannot be time spent during a routine encounter. Provide access to CCM services 24/7 give patients a way to make timely contact with health care providers to address urgent chronic care needs. What You Need to Do Insure the patient has continuity of care with a designated practitioner or member of the care team, and is able to get successive appointments with them. The designated member of the care team does not need to be a DO or MD. Provide care management of chronic conditions that includes: Systematic assessment of patient s medical, functional and psychosocial needs. System-based approaches to ensure timely receipt of all recommended preventive care services. Medication reconciliation with review of adherence and potential interactions. Oversight of patient self-management of medications.

5 Create a patient-centered care plan document to assure care is provided in a way that is compatible with patient choices and values and provide a written or electronic copy of the care plan to the patient. What You Need to Do (continued) Manage care transitions between and among health care providers and settings. Coordinate with home and community-based clinical service providers as appropriate. Offer enhanced opportunities to communicate with you and your team to the patient and any relevant caregiver. Many of these responsibilities are already part of other programs such as Patient Centered Medical Home and Meaningful Use. For most providers that manage patients with two or more chronic conditions, these responsibilities are already part of the practice s routine workflow.

6 That only one practitioner can furnish and be paid for these services during a 30-day period. What the Patient Agreement Must Explain That the patient can terminate the agreement verbally or in writing at any time. That Medicare co-insurance payments apply and that a co-insurance payment of approximately $8 per month will be billed for each 30-day period that your practice bills for the service. The types of Chronic Care Management Services that your practice provides (see the list captioned above and be sure to include the copy of the care plan).

7 Medicare has assigned CPT code for this service Be certain that the CCM services (20 minutes of care) were provided and that a patient agreement is on file How to Bill for Chronic Care Management Do not bill this service for a routine in-person encounter Bill the CPT code no more than one time per 30-day period Note: While the code was designed primarily to help primary care providers to be paid for chronic care management, specialists can also bill under this code if they are providing chronic care management. However, if the patient s primary care physician is one of your main referral sources and you expect they may want to bill for CCM you may want to defer to the primary for this service, as it will preclude their claim. Remember: You can only bill in months when there s activity. Many times when managing chronic care patients, you may reach out to them periodically. Today you are not paid for this type of ongoing care, but under this new rule if you spend 20 minutes providing care to the patient in a 30-day period, you can bill under the new CCM code.

8 Your EHR needs an interface that creates a virtual list of all your patients that have FFS Medicare and at least 2 Chronic Conditions Next your EHR must narrow that list of patients real-time to ones that: What Your EHR Software Should Do - Have had activity outside of an in-person or telemedicine encounter with the patient - Have a signed CCM patient agreement incorporated into the medical record Finally your EHR must have a way to create bills easily each 30-day period with the new CPT code for every patient that meets the first 2 conditions. It must track whether the code was already billed during the 30-day period and also remind you to bill the service when appropriate before the billing period expires. Not every software solution has the ability to make billing for CCM services simple; look for EHR solutions that include a CCM module that assists your practice in optimizing this new revenue opportunity

9 Jan What s the Timeline? This rule is part of the Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2015, which means that it goes into effect on January 1, But we recommend you begin informing your patients now and obtain their signed agreement that they want to participate in this program. Only one provider can be paid for these services during a 30-day period, so you will want to insure you know which of your patients want to participate with you and reach out to them before another provider does.

10 Note: This information was current as of November 13, The Medicare rule is final, but between this date and the implementation date of Jan. 1, 2015, Medicare reserves the right to clarify the rule. We will update this document with those clarifications as they become available. American Medical Group Association Summary of Key Provisions - Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2015 Sources Medicare Program Revisions to Payment Policies Under the Physician Fee Schedule See section K for Chronic Care Management (CCM) Services CMS proposes payment for chronic care management in 2015 Contact HealthFusion today to learn how MediTouch EHR makes billing for CCM services simple. (855) HealthFusion.com