reimbursing chronic care management
DESCRIPTION
CMS has finally made chronic care management is reimbursable. Learn how your PCMH and care coordination efforts can now be billed.TRANSCRIPT
Reimbursing Chronic Care Management (CCM)Wednesday, October 29th, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.
The concept has always sounded simple; reduce costs and improve care.
It’s been proven that Care Management of chronic disease accomplishes both, so why were Care Management programs
unpopular?
Lack of Payment• Most payers bundle payment for non-face-to-face
interaction.Costs
• Staff• Technology• Time
Software Limitations• Care Management limitations in PM systems and
integrated tools were lacking
Is there any clearer message? CMS will be reimbursing providers for Care Management services Effective
January 1, 2015.
CMS acknowledged that 75% of our healthcare spending is directly related to chronic conditions. It sends a clear message that the costs associated with chronic disease drives the decision to encourage care management in our
society.
Non-face-to-face (NF2F)Often times, the following items below were viewed as bundled into the E&M codes. It has since been recognized that the items were under valued and an important part of the care management of the patient:
Work that includes answering patient phone messagesWork that includes answering patient electronic messagesSorting through formulary changesResponding to labs or consultation recommendationsProviding weekend coverage.Providing night emergency coverage
The Policy No Longer Bundled
• When billed with the following services:• E&M• AWV• IPPE
• Separate payment for non-face-to-face chronic care management services for Medicare beneficiaries
Bundled• When Billed with the following services:
• Home Health• Hospice• TCM • Nursing Home
Criteria• Medicare patient • Expected to live 12 months or until death• Multiple, significant chronic conditions (two or more)
Reimbursement
Reimbursement• Roughly $42.00• Subject to Co-Payment• Time Based- 20 Min • HCPCS Code to be released in November
Submission• Once per month, per qualified patient provided that medical needs
of the patient involve the following as it relates to the care plan:• Establishing• Implementing• Revising• Monitoring
Requirements
Documentation in the patient’s medical record that all of the chronic care management services were explained and accepted by the patient• Document Time and Service Provided
A written agreement that electronic communication of the patient’s information with other treating providers is part of care coordination
Information about the availability of the services from the practitioner
A written or electronic copy of the care plan that is provided to the beneficiary and recorded in the electronic health record (EHR).
Stipulated ServicesThough it’s anticipated that there will be additional requirements forthcoming, the list below are identified as expectations for CCM:
Continuity of care with a clinician or practiceCare management that provides the following:
• A systematic assessment of medical, functional, and psychosocial needs
• A system-based approach for timely delivery of preventive services
• Medication reconciliation• prescription and nonprescription• review of interactions and adherence
Stipulated ServicesThe creation of an updatable patient-centered plan of careManagement of all care transitionsAn EHR that is available 24/7 to both the the caregiver as well as
the patient. Opportunities for patient-to provider communication via
telephone or secure asynchronous NF2F messaging
Where do you begin? Identify patients that meet the minimum criteria Begin the communicationEstablish your written protocols Identify the appropriate staff who comprise your clinical care
management team.Pursue PCMH designation Establish your strategy
