Research studies have demonstrated time and again that care management reduces total costs of care for chronic disease patients while improving their overall health. Despite these impressive results, patients receiving care management services remain the exception, not the rule.

Historically, payers have taken the position that payment for non-face-to-face care management services (e.g., medication reconciliation, coordination among providers, arrangements for social services, remote patient monitoring) is bundled into the payment for face-to-face evaluation and management (E&M) services. But these payments do not cover the significant staffing and technology investments required for chronic care management, and thus practitioners do not usually furnish these services.

As a result, chronic disease patients are too often left to manage for themselves between episodes of care. That pattern of sporadic care translates into higher complication rates which, in turn, means more suffering and costly care.

New Medicare Payment for CCM

Beginning January 1, 2015, Medicare now pays for chronic care management, or CCM. As detailed below, CCM payments will reimburse practitioners for furnishing specified non-face-to-face services to qualified beneficiaries over a calendar month.

Specifically, CMS has adopted CPT1 99490 for Medicare CCM services, which is defined in the CPT Professional Codebook as follows:

“Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.”

CMS Developed the requirements for providing and billing for CCM over a three-year period. To fully understand those requirements, one must review the three different proposed and three different final rules CMS published during that period. We have analyzed those rules carefully and condensed them down to three core requirements a provider must meet to bill for CCM:

  1. Secure the eligible beneficiary's written consent
  2. Have five specified capabilities needed to perform CCM
  3. Provide 20+ minutes of non-face-to-face care management services per calendar month

In this White Paper you will find a complete discussion of each core requirement. It will provide an explanation of potential revenue; address which providers can bill for CCM; outline which Medicare beneficiaries are eligible for the service; and offer next steps for providers instead of furnishing CCM.

To read the full White Paper click the button below.