Medicare and understanding the Centers for Medicare & Medicaid Services (CMS) is no easy task: there are meaningful use policies, attestations, and chronic care management that you can implement into your practice.
The American College of Physicians defines chronic care management as “the non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more), significant chronic conditions.”
According to their website, the CMS’s Medicare Physician Fee Schedule (PFS) as of 2015 has begun making separate payments for CCM services.
This provides incentive for a new outlet of revenue, which is invaluable considering the high costs that surround the healthcare industry. In order to further understand how to be eligible for CCM services and payments, we will cover the new requirements and how it will affect your practice.
CCM: What Does it Entail?
CCM has a set list of eligibility requirements that must be met before enrollment. They are:
Certified EHR software for CCM codes that abides by the 2011 or 2014 criteria set forth by the EHR Incentive Program (this includes demographics and an any-time accessible summary of care record)
The CMS’s definition of 2 chronic conditions, which are expected to last at least 12 months or result in death, which “place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.”
Only physicians, physician assistants, and qualified nurses are able to code for CCM codes
A signed patient consent form containing an agreement of 20 minutes of out-of-the-office follow-up care once a month
Only 1 provider per patient can bill under CCM each month (this is the physician providing the primary care to the patient)
Copayments apply, including deductibles
Be advised there are restrictions as to what is considered appropriate billing for the monthly 20 minutes. Also, if a patient wishes to opt out of CCM, they must provide notification in writing to his or her selected physician’s office their desire to terminate CCM services.
While many physicians are showing interest in CCM services, there is a delay surrounding implementation. This is largely due to a lack of certified EHR software that offers “a method for tracking and billing the Chronic Care Management code,” according to HealthFusion.
The problem with EHRs isn’t just with CCM: a slew of unsatisfied outcries have been ongoing due to inadequate EHR usability and functionality. Many practices are having a difficult time with usability, not to mention implementation costs and training that detracts from daily billing and office duties.
The changes for CCM and Medicare won’t end here—if anything, this is just the beginning of integrating different payment models and reimbursement figures into the healthcare system. We hope this information has been helpful in developing your knowledge about chronic care management, and how Medicare payments and policies will be affected for those who are applicable!