Chronic Care Management (CCM) Services Presented by Noridian Part B Medicare Provider Outreach and Education December 2015
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ACRONYM AWV CFR EHR E/M HIPAA IOM MLN MPFS DESCRIPTION Annual Wellness Visit Code of Federal Regulations Electronic Health Records Evaluation and Management Healthcare Insurance Portability and Accountability Act Internet Only Manual Medicare Learning Network Medicare Physician Fee Schedule December 2015 3
Agenda Chronic Care Management (CCM) Overview Eligible Beneficiaries Eligible Providers Scope of Service Billing Noteworthy Q&As Resources December 2015 4
Objective To give providers tools and information about the Chronic Care Management (CCM) program, how to bill and document appropriately December 2015 5
Chronic Care Management (CCM) Overview December 2015 6
Overview Chronic Care Management Effective January 1, 2015 Critical components of primary care Contributes to better patient health and care Reducing Medicare spending Reimburses eligible providers for non face-toface care coordination services December 2015 7
CCM Basics Furnished to patients with multiple chronic conditions Need signed patient s prior written permission Form created by provider Retroactive consent not allowed Expected to last at least 12 months or until patient death Comprehensive care plan established, revised, implemented and monitored December 2015 8
CCM Basics2 Team scope of service extensive 24/7 patient access to physician/staff services Access to electronic patient records, plan of care revision, medical, functional and psychosocial needs Communicate with other treating professionals Includes time spent by clinical staff Without direct physician supervision General supervision if incident to met December 2015 9
Comprehensive Care Plan Medication management Community/social services ordered Agency specialists/services (outside the practice) who will direct/coordinate Expected prognosis Measureable symptom management with planned interventions Schedule periodic review and care plan revision December 2015 10
Eligible Beneficiaries December 2015 11
Eligible Population Beneficiaries with multiple (two or more) chronic conditions Expected to last at least 12 months or until patient death Beneficiary at Significant risk of death Acute exacerbation Decompensation Functional decline May include approximately 2/3 of all Medicare beneficiaries to be covered December 2015 12
Chronic Conditions* Alzheimer s disease and related dementia Arthritis Asthma Atrial fibrillation Autism spectrum disorders Cancer Chronic Obstructive Pulmonary Disease December 2015 13
Chronic Conditions*2 Depression Diabetes Heart Failure High Cholesterol Hypertension Ischemic Heart Disease Osteoporosis *Not all inclusive list December 2015 14
Beneficiary Access to Provider Team 24/7 access to care management services On call availability In compliance with HIPAA, using secure internet, messaging, telephone, etc. Continuity of care with a designated member of the care team Able to obtain routine appointment December 2015 15
Eligible Providers December 2015 16
Practitioners Eligible Physicians Certified Nurse Midwives Clinical Nurse Specialists Nurse Practitioners Physician Assistants December 2015 17
Clinical Staff Eligible Eligible to contribute their time to the monthly CCM documentation Medical Assistants Nurses Pharmacists Technicians Therapists December 2015 18
Practitioners Not Eligible Cannot bill, but may refer/consult Clinical Psychologist Dentist Podiatrist Their time counts toward monthly service Non clinical staff time does not count Billers Other administrative staff December 2015 19
Supervision Exception under incident to rule Clinical staff under general supervision Overall direction without physician presence Rather than direct supervision Where physician must be in the clinic/office December 2015 20
Scope of Service December 2015 21
Scope of Service Provider needs beneficiary prior informed consent obtained only once Unless patient changes eligible practitioner Create form-written informed consent or decline Let patient know Only one practitioner can furnish and bill Right to discontinue CCM verbally or in writing Cost sharing applies Coinsurance and deductible December 2015 22
Scope of Service2 Structured recording of demographics, problems, medications, medication allergies and the creation of a structured clinical summary record, using a certified EHR Certified EHR technology December 2015 23
Scope of Service3 Systematic assessment of health needs and receipt of preventive services Assessment of medical, functional and psychosocial needs Approach to ensure receipt of recommended preventive services Medication reconciliation Oversight of management of medication December 2015 24
Scope of Service4 Electronic care plan Create/maintain comprehensive plan of care Electronically capture plan of care Available 24/7 to practitioners within the practice Whose time counts towards requirement Exchange care plan summary electronically (other than by fax) with other practitioners Written/electronic copy to patient/caregiver, documenting EHR provision for CCM December 2015 25
EHR and Other Electronic Technology Requirements Certified EHR technology Version acceptable under EHR Incentive Program December 31 st of each year preceding Medicare payment year http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms Calendar year 2015 May use EHR technology certified to 2011 or 2014 editions of certification criteria December 2015 26
Comprehensive Care Plan Problem list Expected outcome and prognosis Measurable treatment goals Symptom management Planned interventions and identification of individuals responsible for each intervention December 2015 27
Care Management Service Systemic assessment Patient s medical/functional/psychosocial needs System based approaches ensuring receipt All recommended preventive care services Medication reconciliation with review Adherence and potential interactions Oversight of patient Medication self management December 2015 28
Managing Care Transitions Between health care providers and settings Include referrals to other providers Providing follow-up after an emergency department visit and after discharges from hospitals, skilled nursing facilities or other health care facilities December 2015 29
Other Coordination Opportunities Coordination with home and communitybased clinical service providers as appropriate Communication to and from these providers Methods are subject to HIPAA Enhance communication opportunities for patient and caregivers December 2015 30
Billing December 2015 31
CCM Billing Only one practitioner bills/allowed monthly Non F2F services 99490 Reimburse approx. $40 monthly Place of Service (POS) = 11 (Office) 20 minutes or more; per 30 calendar days Aggregated/documented by different clinicians Deductible/Coinsurance apply Before CCM, provider billing must furnish AWV or comprehensive E/M December 2015 32
Other CCM Not Covered B (bundled) not separately covered 99487/99489 Complex Chronic Care Management 99090/99091 Remote patient monitoring or analysis of patient-generated health data As long as not the only work performed, may count towards minimum 20 minutes December 2015 33
Other Monthly Services Medicare does not make duplicate payment for similar services Do not bill same month as Transitional Care Management (TCM) 99495-99496 End Stage Renal Disease (ESRD) 90951-90970 Home Health/Hospice Care G0181-G0182 December 2015 34
Payment Information Payment for CCM service Separate under Medicare fee schedule Medicare Physician Fee Schedule (PFS) Look Up tool http://www.cms.gov/medicare/medicare-feefor-service-payment/pfslookup December 2015 35
Noteworthy Q&As December 2015 36
Q & A What date of service should be used on the physician claim and when should the claim be submitted? The service period for CPT 99490 is one calendar month and CMS expects the billing practitioner to continue furnishing services during a given month as applicable after the time threshold is met. When the 20 minute threshold to bill is met, the practitioner may choose that date of service and not hold the claim until the end of the month. December 2015 37
Q & A2 Can CCM services be subcontracted out to a case management company? What if the clinical staff are located outside of the United States? A billing physician (or other appropriate practitioner) may arrange to have CCM services provided by clinical staff external to the practice (e.g. case management company) if all the "incident to, state scope of license and other rules for billing CCM are met. Note: There is a regulatory prohibition against payment for non-emergency Medicare services furnished outside of the United States (42 CFR 411.9), CCM services cannot be billed if provided to patients located outside of the U.S. December 2015 38
Resources December 2015 39
Medicare Learning Network (MLN) Official CMS for Medicare FFS Providers Products available: Web-based Training Brochures Fact Sheets Quick Reference Charts Most products come in downloadable/hardcopy formats MLN products FREE of charge and shipping MLN dedicated web pages: MLN General Information -- http://www.cms.gov/mlngeninfo MLN Articles -- http://www.cms.gov/mlnmattersarticles MLN Products -- http://www.cms.gov/mlnproducts MLN Web Guides -- http://www.cms.gov/mlnedwebguide December 2015 40
CMS Booklet Current May 2015 11 pages https://www.cms.gov/ Outreach-and- Education/Medicare- Learning-Network- MLN/MLNProducts/D ownloads/chroniccar emanagement.pdf December 2015 41
Other CMS Resources December 2015 42
CMS Resources ICD-10 Questions? https://www.cms.gov/medicare/coding/icd10/ index.html http://www.roadto10.org/ Small practice providers no-cost tool Noridian Resources JE https://med.noridianmedicare.com/web/jeb/topics/ icd-10 JF https://med.noridianmedicare.com/web/jfb/topics/ icd-10 December 2015 43
Reminder: Noridian Not Coders Providers are responsible for determining correct diagnostic/procedural coding to Medicare Noridian Customer Service Representatives (CSRs) shall not make provider determinations about proper use of codes Please refer to other entities for coding sets CPT and HCPCS manuals AMA or specialty association websites American Academy of Professional Coders (AAPC) December 2015 44
Continuing Education Unit (CEU) Attend entire workshop to earn CEU(s) Prefer individual registrations Take short polling survey Pops up after closing out of webinar CEU emailed 3 days after presentation Earn 1.0 CEU today No password/index number needed for AAPC PDF presentation emailed again with CEU Q/A posted after 30 business days December 2015 45
Questions? Thank you!