Chronic conditions are long-term illness such as cancer, diabetes, chronic bronchitis, congestive heart disease depression, asthma, cirrhosis of the liver, hypertension etc. which requires an extended period of care.
The Chronic Care Management at CMS is intended to provide 20 minutes non face-to-face services for patients suffering from two or more chronic conditions by providers, they can either use mHealth or telehealth technology to fulfill the CCM criteria.
CMS has emphasized the importance of care in population health. From 2015, it has started to pay Medicare providers for providing CCM service of 20 minute for 30 day calendar month. Under CPT code 99490, eligible providers are paid $42.60(average) per Medicare patient only to those patients who have agreed to pay 20% co payment.
The reason behind this payment is to improve the wellness of the people. Increase in the number of chronic diseases and poorly coordinated US healthcare system makes chronic care patients to suffer. It is estimated that by 2030 half of the US population might have more than one chronic conditions. After providing this extended care service, healthcare has seen a significant improvement in care. Offering aftercare service post hospital visits shows positive results in health outcomes.
CCM scope of service
The CCM service includes a recording of patient health data, an electronic care plan, access to care management services, managing transitional care, and coordinating and sharing patient information.
1. The structured way of recording data
A patient record should contain details of demographics, problems, medications and medication allergies in a structured clinical summary record using certified EHR technology.
2. Creating e-care plans
a. A patient-centered care plan is created based on a physical, mental, cognitive, psychosocial, functional, and environmental needs of the patient.
b. Any modification in care plan should be recorded and updated in the patient medical record.
c. Ensure this care plan can be accessed by any physician inside and outside the network.
3. Access to Care Management services
a. 24/7 Service
Giving 24/7 service a day in per calendar month for patients to make timely contact with health professionals during or after emergency.
b. Care Continuity
A patient can communicate with care providers, make successive routine appointments easily and also get suggestions or advice on medications via telephone, secure messaging, or video calling.
4.Manage Care
Care Management Service includes a systematic way of assessing patient needs, system-based approach to billing process, and medication reconciliation.
5. Managing care transitions among providers
With the use of electronic medical records, it is easy for providers to make quick referrals and follow up process during and after an emergency with skilled nurses, and practitioners.
6. Coordination
CCM services also help to coordinate with home and community based clinical facilities by sharing patient data with providers and practitioners outside of the network.
Documentation/ Billing
Each practice will have its own system of documentation for billing. 20 minutes of non-face-to-face service should be taped in a more detailed form, including caregiver name, time logs, physician feedback, record changes in a care plan, and integrated with EHR.
In order to avoid duplicate payment, CMS pays Medicare providers separately for care management and CCM service as it believes that care management is an integral part of all of these services.
The CCM CPT code (99490) cannot be billed when the patient also get service under
Transitional care management codes (99495-99496)
Home or community clinical service codes (G0181-G0182)
End-stage renal disease services codes (90951-90970)
Physicians Reimbursement
CMS pointed that providers have to meet other criteria in order to qualify for CCM payments. The criteria are listed below:
1. Using certified EHR
CCM service requires the use of certified EHRs to record the services offered for future reference and documentation purposes.
EHR helps members of hospitals to access patient record at the same time. It helps them to get updated information about patient’s health issues and can give effective treatment.
2. Time spent on CCM service
If many physicians are involved in same patient’s care then each physician are paid for the time spent on care. Time logs will act as a time tracker to avoid duplicate billing.
3. Getting patient approval
To be reimbursed by CMS, patients must agree to pay $8 monthly copay. Since it is a new process and some patients may not understand why they have to pay for something they were previously getting for free.
HealthViewX CCM solution helps to coordinate better care, makes documentation work simple and time monitoring tool to help ease the process of physician reimbursement billing.
