Tag Archives: cpt codes

CMS expands Telehealth Services to Deliver Care Safely during COVID-19 and Beyond

During the COVID-19 pandemic, CMS has taken the necessary steps to make it easier to provide quality care through telehealth services. This unprecedented action by CMS has encouraged healthcare providers to adopt and use telehealth as a way to safely provide care to their patients in situations like medication consultation, eye exams, nutrition counseling, behavioral health counseling, and routine health check-ups like annual wellness visits. Past data have shown telehealth to be an effective medium for patients to access healthcare providers especially for managing chronic conditions like diabetes, asthma or to obtain mental health counseling.

Advantages of CMS changes to Telehealth:

Telehealth services made permanent post-COVID-19:

CMS has announced that 60 of the 144 telehealth services that were newly offered during the pandemic will become permanent. This includes services for cognitive assessment, psychological and neuropsychological testing, and custodial care services for established patients.

They have also finalized the decision that direct supervision in telehealth visits can be provided with interactive audio and video technology through the end of the year until December 2021.

CPT Code	Services	Description
77427	Radiation management	It is reported once for every five fractions or treatment sessions regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days.
90853	Group psychotherapy	Group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.
90953	End-stage renal disease, one visit per month, ages 2 and younger	End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, etc.
90959	End-stage renal disease, one visit per month, ages 12-19	End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth
90962	End-stage renal disease, one visit per month, ages 20 and older	With 1 face-to-face physician visit per month
92057	Speech/hearing therapy	Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual
92521	Evaluation of speech fluency	Evaluation of speech fluency (e.g., stuttering, cluttering)
92522	Evaluation speech production	Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523	Speech sound language comprehension	Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92524	Behavioral quality voice analysis	Behavioral and qualitative analysis of voice and resonance.
96130	Psychological test Evaluation Phys/qhp 1st	Psychological testing evaluation services by a physician or other qualified healthcare professional, including the integration of patient data, interpretation of standardized test results and clinical data
96131	Psychological test evaluation phys/qhp ea	Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour
96132	Neuropsychological testing evaluation phys/qhp 1st	Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96133	Neuropsychological testing evaluation phys/qhp ea	The first hour of neuropsychological evaluation is billed using 96132 and each additional hour needed to complete the service is billed with code 96133
96136	Psychological and neurological testing phy/qhp 1s	Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes
96137	Psychological and neurological testing phy/qhp ea	Similar to 96136. This code is used for each additional hour.
96138	Psychological and neurological tech phy/qhp ea	Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes
96139	Psychological and neurological testing tech ea	Similar to 96138.
97110	Therapeutic exercises	Foundational, occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility.
97112	Neuromuscular re-education	Specific exercises or activities performed and for what purpose, neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture.
97116	Gait training therapy	Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing).
97161	Physical therapy evaluation	Physical therapy evaluation of low complexity, 20 min
97162	Physical therapy evaluation	Physical therapy evaluation moderate complexity, 30 min
97163	Physical therapy evaluation	Physical therapy evaluation moderate complexity, 30 min
97164	Physical therapy evaluation	Physical therapy re-evaluation establish plan care
97165	Occupational therapy evaluation	Occupational therapy evaluation low complexity, 30 min
97166	Occupational therapy evaluation	Occupational therapy evaluation moderate complexity, 45 min
97167	Occupational therapy evaluation	Occupational therapy evaluation high complexity, 60 min
97168	Occupational therapy	Occupational therapy re-evaluation establish plan care
97535	Self-care management training	Direct one-on-one supervision and instruction regarding activities of daily living related to the patient’s health and hygiene.
97750	Physical performance test	Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.
97755	Assistive technology assessment	This procedure is used by the provider to assess the suitability and benefits of technological interfaces that will help restore, augment, or compensate for existing functional ability in the patient.
97760	Orthotic management and training 1st en	Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes.
97761	Prosthetic training 1st enc	Prosthetic training, upper and/or lower extremities, initial prosthetic encounter, each 15 minutes
99217	Observation care discharge	This code is used to report all services provided to a patient discharged from outpatient hospital “observation status” if the discharge is on a date other than the initial date of “observation status
99218	Initial observation care	The first visit of the patient’s admission for outpatient hospital observation care by the Admitting/Supervising Physician or Other Qualified Healthcare Professional. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99219	Initial observation care	Similar to 99218 but, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99220	Initial observation care	Similar to 99218 but, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99221	Initial hospital care	Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.
99222	Initial hospital care	Similar to 99221
99223	Initial hospital care	Similar to 99221
99234	Observation/hospital same date	Observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99235	Observation/hospital same date	Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99236	Observation/hospital same date	Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99238	Hospital discharge day	Used when time spent is less than 30 minutes on the discharge process in face-to-face evaluation.
99239	Hospital discharge day	Used when time spent is greater than 30 minutes on the discharge process in face-to-face evaluation.
99281	Emergency department visit	Requires these 3 key components: A problem-focused history; A problem-focused examination; and Straightforward medical decision-making. Usually, the presenting problem(s) are self-limited or minor.
99282	Emergency department visit	Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of low complexity. Usually, the presenting problem(s) are of low to moderate severity.
99283	Emergency department visit	Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of moderate severity.
99284	Emergency department visit	Requires these 3 key components: A detailed history; A detailed examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.
99285	Emergency department visit	Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.
99291	Critical care first hour	It is used to report the services of a physician providing full attention to a critically ill or critically injured patient from 30-74 minutes on a given date
99292	Critical care additional 30 mins	Code 99292 (critical care, each additional 30 minutes) is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care.
99304	Nursing facility care initial	The problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit.
99305	Nursing facility care initial	The problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit.
99306	Nursing facility care initial	The problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit.
99315	Nursing facility discharge day	99315 is for discharge day management 30 minutes or less
99316	Nursing facility discharge day	This code is for discharge day management over 30 minutes
99327	Domiciliary or rest home visit new patient	Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99328	Domiciliary or rest home visit new patient	Code used for Evaluation and Management / Domiciliary, rest home (boarding home) or custodial care services. The general guidance for this code is that it is used for new patient assisted living visits, typically 75 minutes.
99334	Domiciliary or rest home visit established patient	This code 99334 is used to reflect the domiciliary or rest home visit for the E/M of an established patient
99335	Domiciliary or rest home visit established patient	Similar to 99334
99336	Domiciliary or rest home visit established patient	Similar to 99334
99337	Domiciliary or rest home visit established patient	Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family
99341	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 1 new patient home visit.
99342	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 2 new patient home visit.
99343	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 3 new patient home visit.
99344	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 4 new patient home visit.
99345	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.Level 5 new patient home visit.
99347	Home visit established patient	Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components. A problem-focused interval history; a problem-focused examination; and straightforward medical decision making. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348	Home visit established patient	Similar to CPT Code 99348. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349	Home visit established patient	Similar to CPT Code 99348. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350	Home visit established patient	Similar to CPT Code 99348. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99468	Neonatal critical care initial	Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger.
99469	Neonatal critical care initial	Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger.
99471	Pediatric critical care initial	Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age
99472	Pediatric critical care initial	Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age
99473	Self-measurement of blood pressure at home education/training	Code 99473 represents the work of training the patient and calibrating the device,
99475	Pediatric critical care ages 2-5 initial	Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age
99476	Pediatric critical care ages 2-5 subsequent	Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age
99477	Initial day of hospital care for neonatal care	Initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services.
99478	Ic low-birthweight infant	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( < 1500 gm)
99479	Ic low-birthweight infant < 1500-2500 g subsequent	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( 1500 gm-2500g)
99480	Ic infant pbw 2501-5000 g subsequent	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant(2501g-5000g)
99483	Assessment and care plan cognitive impairment	Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home

The ongoing pandemic has resulted in an increased workload for healthcare providers across the country. Incorporating telehealth software into an existing practice can allow providers to virtually connect with patients. This can relieve the strain on practice while introducing an additional revenue stream.

HealthViewX Telehealth/Telemedicine Platform helps health systems to align clinical, financial, and operational goals by providing high-quality remote care and enhancing patient-physician collaborations.

References: https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

How Can The Healthcare Industry Equip Their Senior Patients For Chronic Care Management?

Healthcare organizations and chronic illness

By 2029, estimates show that senior patients will make up 20% of the population and a considerable share of healthcare spending. As it stands now, senior patients and patients with chronic illness make up to 5% of the population but nearly 50% of healthcare spending. How can healthcare organizations cap these rising costs.

According to a report from BDO Center for Healthcare Excellence & Innovation, healthcare organizations are taking more responsibility when it comes to older adult care and chronic care management,

From NEJM Catalyst survey, it was found that healthcare organizations are looking into

Home health services
Strong chronic disease plans
Health IT

to address the needs of a growing aging population.

How can healthcare organizations achieve patient-centric and value-based care?

As mentioned earlier, healthcare organizations are looking into home health services and care plans to treat patients with chronic diseases.

Home healthcare services – Home healthcare is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility. Examples of home health services include:

Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status

In general, the goal of home health care is to treat an illness or injury. Home health care helps you:

Get better
Regain your independence
Become as self-sufficient as possible
Maintain your current condition or level of function
Slow decline

Strong chronic disease plans – Patients with one or more chronic diseases need doctor’s attention almost every day. The physicians create care plans for such patients with vitals, measurements, activities, pain, etc that need to be monitored. This will help in keeping chronic patients healthy if they follow the care plan strictly.

HealthViewX Care Management and Chronic Care Management solution to ease the process for healthcare organizations

Information technology helps in making the process simpler for healthcare organizations by reducing their time and effort. HealthViewx software provides Care Management and Chronic Care Management solutions which help in providing home health services and also care plans for chronic patients.

HealthViewX Care Management solution supports the following features,

Care plans to enable remote care – A provider can create a care plan for a patient depending on the vitals, treatments, measurements, etc that need to be tracked. The patient-centric application helps in logging data for the vitals specified in the care plan. If needed the care plan can also be printed.
Customizable dashboards to suit the need – Dashboards comprising of graphs and tables show a comprehensive data of the number of patients in different care plans depending on the patient diagnosis.
Scheduler to keep track of the appointments – An inbuilt scheduler keeps track of the appointments and sends timely reminders to both the patient and the provider. The chances of missing out an appointment are very less.
Audio and video calling features – HealthViewX Care Management solution support inbuilt audio and video calling features which help in connecting with the patients for follow-ups.
Patient-reported data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the providers in monitoring the patient vitals. The patient records can be anytime printed in pdf or excel report form.
Health device integration – HealthViewX Care Management solution can integrate with any wearable device like Fitbit, apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.

HealthViewX Chronic Care Management solution supports the following features,

Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Care Management and Chronic Care Management solutions have features that suit healthcare organizations best. To know more about our solutions, schedule a demo with us.

How Is CMS Changing The Face Of Remote Patient Monitoring And Patient Access?

CMS has finally issued its 2019 Physician Fee Schedule Proposed Rule. It has highly anticipated new reimbursement policies for telehealth, remote monitoring, with a stronger focus on patient access to health information.

The new codes for Patient Remote Monitoring

The 2019 Proposed Rule offers three codes through which providers can get reimbursements for integrating remote monitoring data into their practice.

The first two are practice expense codes, which include resources providers spend such as office rent, supplies, and medical equipment. The third code tracks the amount of time a care provider spends managing patient care using the remote monitoring data.

990X0 – Remote monitoring of physiologic parameter(s). Covers the time providers spend on setting up the technology and explaining to patients how it works.
990X1 – Remote monitoring of physiologic parameter(s). Covers device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
994X9 – Remote physiologic monitoring treatment management services. Covers 20 minutes or more of clinical staff, physician, or other qualified healthcare professional time in a calendar month. The code requires interactive communication with the patient and/or the patient’s caregiver during the month.

There are some challenges in the proposed codes. These codes only cover the exchange and interpretation of “physiologic” data; yet many providers today would agree that there is a wealth of patient data that is helpful at the point of care, including patient-reported outcomes or behavioral data, that would fall outside the definition of physiologic.

Further guidance may be helpful to determine exactly which providers on a care team can spend time working with remote monitoring data. While the code definition states “clinical staff, physician, or other qualified healthcare professional,” elsewhere in the PFS proposed rule refers to the term “practitioner,” which “is used to describe both physicians and non-physician practitioners (NPPs) who are permitted to bill Medicare under the PFS for the services they furnish to Medicare beneficiaries.”

New Reimbursement for “Communication Technology-Based Services”

CMS acknowledges the evolution of physician services furnished through communication technology. So Medicare enacted the telehealth services statutory provision for patients with chronic conditions. Recognizing the many statutory restrictions on telehealth in Section 1834 (m) of the Social Security Act, CMS has taken the interpretation that there are physician services that involve interaction with a patient via remote communication technology that are not considered telehealth services and therefore are not covered by these restrictions.

CMS proposed several new HCPCS codes that are not considered “telehealth” services and as such, not subject to the conditions of Section 1834 (m):

HCPCS code GVCI1 – Brief Communication Technology-Based Service, e.g. Virtual Check-in. This would include the kinds of brief non-face-to-face check-in services furnished by a physician or other qualified healthcare professional, using communication technology, to evaluate whether or not an office visit or other service is warranted.
HCPCS code GRAS1 – Remote Evaluation of Pre-Recorded Patient Information. This covers physician time spent reviewing patient-submitted video or images to determine if a follow up visit is needed.

CMS acknowledges modern communication technology that allows for “the kinds of brief check-in services furnished using communication technology that are used to evaluate whether or not an office visit or other service is warranted.”

Beginning January 1, 2019, CMS is proposing to pay providers for utilizing these types of preventative technology services, even in cases where the activity means that a follow-up office visit is not scheduled. Where the check-in services precede an office visit or follow a visit within the previous 7 days, they would be bundled into the payment for the visit, but where the service does not lead to an office visit, there could be a separate payment.

CMS is seeking comments on the implications of this approach, as well as more information from industry about the types of technologies in use today to achieve these goals. Additionally, CMS seeks insight from industry as to if,

These services are appropriate for new patients
They are only for existing patients
Patient consent is required

Health Information Technology to simplify the process

Information Technology can greatly simplify the process by making remote patient monitoring easy for the hospitals. HealthViewX is a healthcare product that provides solution for remote patient monitoring, chronic care management and referral management. Our product has many unique features that simplify the workflow and improves patient satisfaction. To know more about our solution, schedule a demo with us.

References

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

How Can Referral Inbound-Heavy Practices Profit From Patient Referrals?

Why are patient referrals important?

Patient referrals are excellent sources of revenue for health systems. Why is it necessary to have referrals flowing into your network? When a practice receives more referrals, it means patients will visit that practice. It has a positive impact on your revenue. When patients regularly visit a practice, the practice always stays active in the healthcare industry. But inbound-heavy referral practices can use technology to take care of their patient referrals.

What are the challenges faced by a referral inbound-heavy practice?

Multiple referral channels – For the specialist/imaging center who receive referrals face more difficulties than the referring provider. The receive referrals through various channels like fax, email, direct message, website, user-filled forms, etc. It is difficult to track and manage such a high volume of referrals. Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in. The chances of missing out on a referral are high.
Time-consuming process – On an average, referral inbound-heavy practices receive 1000 plus referrals every day. Handling all of them manually is a time-consuming process. The practice is aware of how many were processed and how many need immediate attention.
Limited referral information – Many referrals have less or no information required to process them. It makes it difficult for the referral coordinator to proceed with the diagnosis. It takes a lot of time for a practice to contact the referring provider for information or clarifications.
Appointment scheduling and patient no-show rates – After receiving the referral, the practice schedules appointments with the patient. In some cases, the patients are not notified clearly about the appointment. When patients do not show up, it is difficult for a practice to track.

How can an Electronic Patient Referral Management help referral-inbound heavy practices?

The current referral management is no way close to the increasing demands of the referral process. It provides no option for communicating between the referring and the receiving ends. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the current requirements. Electronic Referral Management has been creating buzz for some time.

Inbound patient referral management challenges can be resolved to improve operational efficiency, reduce inbound patient referral leakage and close the loop of patient referrals. A patient referral management software must have the following benefits,

Consolidating the referral channels – The system must handle referrals from email, fax, phone, referral slips and direct visits. The software must consolidate referrals from all sources into a single queue from where it can be processed.
Data security – The software must manage all sensitive patient-related data securely.
Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc. Patient referral system should give a clear picture of how efficient the practice is in handling inbound referrals.
Referral history – The history must be common to both the referring physician and receiving specialist/imaging center. The progress of the patient referral from the time of referral initiation and subsequent diagnosis should contain patient diagnostic reports, referral status to ensure there is no missing information.
Integration with scheduler – This will help in scheduling appointments for the patients. Also, the system should send automated reminders to patients and physicians about the appointments.
HIPAA Compliant – This will enable secure data exchange of patient sensitive documents.

HealthViewX Patient Referral Management Solution features

Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website referrals and manages them in a single interface. This helps in managing them better.
Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. The provider can attach documents at any time for one another’s reference.
To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications.
Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely. It helps in secure exchange of data.
Referral Analytics – Helps in tracking the number of referrals and gives complete information about the number processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps practices in managing their referral network and increasing their revenue. Are you a referral inbound-heavy practice looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

What is Complex Chronic Care Management – All you need to know

Chronic Care Management

The Centers for Medicare & Medicaid Services (CMS) considers Chronic Care Management (CCM) as a crucial part of primary care. Chronic Care Management is non-face-to-face care provided to Medicare patients with two or more chronic conditions. It contributes to better health services to people. In 2015, Medicare started to reimburse a certain amount for the Chronic Care Management services under the Medicare Physician Fee Schedule (PFS).

Service Codes

CPT 99487 – Complex chronic care management services 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, or functional decline
- Establishment or substantial revision of a comprehensive care plan
- Moderate or high complexity medical decision-making
- 60 minutes of clinical staff time directed by a physician or other qualified care provider, per calendar month
CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified care provider, per calendar month (List separately in addition to code for primary procedure)

Difference Between CCM and Complex CCM

CCM (“non-complex” CCM) and complex CCM services have similar health service elements. They differ in the following aspects,

Amount of clinical staff service time provided
Involvement and work of the billing practitioner
The extent of care planning performed

According to Medicare, “Complex Chronic Care Management services of less than 60 minutes in duration, in a calendar month, are not reported separately. Practitioners must report CPT 99489 in conjunction with CPT 99487. They must not report CPT 99489 for care management services of less than 30 minutes along with the first 60 minutes of Complex Chronic Care Management services during a calendar month.”

Eligibility Criteria for Care Providers

Physicians and the following non-physician practitioners may bill CCM services:

Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants

Patient Eligibility

Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

Expected to last at least 12 months or until the death of the patient
Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline

As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible Medicare patients. The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex Chronic Care Management services during a given service period, not both.

Supervision

The Complex CCM codes (CPT 99487, 99489) come under the general supervision according to Medicare PFS. A billing practitioner need not give the health service personally. Any qualified care provider can give the service under the billing practitioner’s overall direction and control. The billing practitioner’s physical presence is not required.

CCM Service Summary

Care providers give a non-complex or complex Chronic Care Management service through the following steps,

Initiating Visit – Medicare requires initiation of CCM services for new patients or patients not seen within one year of commencement of CCM. It is a face-to-face visit with the billing practitioner. It includes an Annual Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or other face-to-face visits. This initiating visit is not part of the CCM service and is separately billed.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of patient’s demographics, problems, medications, and medication allergies using certified Electronic Health Record (EHR) technology.
Comprehensive Care Plan – A person-centered, electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment. The care provider must,

Provide the patient and/or caregiver with a copy of the care plan
Ensure the electronic care plan is available and shared timely within and outside the billing practice to people involved in the patient’s care

24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified care providers or clinical staff and continuity of care with a designated member of the care team.
Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution has features that satisfy non-complex and complex CCM services. Medicare reimbursements for Chronic Care Management services increase the profits for community health centers. It also benefits patients with multiple chronic health conditions. To know more about our Chronic Care Management solution, schedule a demo with us.

Remote Care And How Chronic Care Management Simplifies It

Healthcare industry of the US has introduced many technologies to give the best care to all irrespective of their place, accessibility, etc. Remote Care to patients is the latest healthcare technology. It enables monitoring of patients’ health outside conventional clinical settings. This may increase access to care and cut down the healthcare delivery costs. Hospitals offer Telehealth services as a part of Remote Care. This includes,

Virtual Consultation – It is a virtual visit that takes place between the patient and the physician. It takes place through audio or video calls. It is effective for common problems like flu, acne, fever, etc. It reduces the patient’s traveling cost and provides better access to quality care.
Remote Health Monitoring – Patient Health Monitoring is the latest technology in the healthcare industry. Patient physiological data like blood pressure, blood sugar, heart rate, etc can be measured by external devices. It can be a Fitbit, apple watch, etc that can communicate with the system in the hospital. It will help the physician to always keep an eye on their patients’ vitals and prescribe telemedicine and preventive care plans.
Chronic Care Management – Chronic Care Management is non-face-to-face care provided to patients with multiple chronic conditions. Medicare reimburses a certain amount for the Chronic Care Management services given by the hospital. Chronic Care Management is most administered through audio calls.

As Chronic Care Management services have reimbursements, physicians must consider administering CCM to the eligible patients. Medicare provides Chronic Care Management services for patients with multiple (two or more) chronic conditions

Expected to last at least 12 months or until the death of the patient.
Places the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.

CCM Service Summary

The following are steps through which a Chronic Care Management service is furnished,

Initiating Visit – Initiation during an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of Chronic Care Management services.
Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications, and medication allergies using certified EHR technology.
24/7 Access & Continuity of Care – Provide 24/7 access to physicians or other qualified healthcare professionals or clinical staff and continuity of care with a designated member of the care team.
Comprehensive Care Plan – Creation, revision, and/or monitoring of an electronic person-centered care plan.
Enhanced Communication Opportunities – Enhanced opportunities for the patient to communicate with the physician through not only telephone access, but also the use of secure messaging, Internet, or other non-face-to-face consultation methods.

Eligibility Criteria for Physicians

Physicians and the following non-physician practitioners may bill CCM services:

Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants

HealthViewX Chronic Care Management solution features

HealthViewX Chronic Care Management solution has the following features that make the process simpler,

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture from the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA-compliant. It facilitates secure data exchange. All patient-related documents are managed securely.

HealthViewX Chronic Care Management solution is on par with the current requirements. Remote care is the easiest and the cheapest way to treat your patients. Medicare provides reimbursements for Chronic Care Management which makes it the best way to give care to patients from the remote. To know more about our Chronic Care Management solution, schedule a demo with us.

Advantages of CMS changes to Telehealth:

Telehealth services made permanent post-COVID-19:

CPT Code

Services

Description

Healthcare organizations and chronic illness

How can healthcare organizations achieve patient-centric and value-based care?

HealthViewX Care Management and Chronic Care Management solution to ease the process for healthcare organizations

The new codes for Patient Remote Monitoring

New Reimbursement for “Communication Technology-Based Services”

Health Information Technology to simplify the process

Why are patient referrals important?

What are the challenges faced by a referral inbound-heavy practice?

How can an Electronic Patient Referral Management help referral-inbound heavy practices?

HealthViewX Patient Referral Management Solution features

Chronic Care Management

Service Codes

Eligibility Criteria for Care Providers

Patient Eligibility

Supervision

CCM Service Summary

HealthViewX Chronic Care Management solution features

CCM Service Summary

Eligibility Criteria for Physicians

HealthViewX Chronic Care Management solution features