According to a KFF report, over 67 million people in the United States are enrolled in Medicare and Medicare Advantage programs, and CCM (chronic care management) is a viable new source of revenue for the participating organizations. In fact, healthcare facilities with chronic care management experience an increase in revenue streams in the 2022 Physician Fee Schedule final rule. CMS (Centers for Medicare & Medicaid Services) considers CCM an essential service that can provide significant benefits to patients, one which it has and will continue to promote as time goes on.
Knowing the fundamentals before starting a chronic care management (CCM) program for increased profitability is essential. Take note of the CMS coding and billing guidelines, changes to the care model, and the best ways to begin. This guide will provide you with a checklist to ensure the successful development of the CCM program.
What is a CCM-Eligible Chronic Condition?
Medical conditions that last for a minimum of 12 months or the patient’s entire life are considered chronic conditions. When a patient is battling two or more conditions, they are eligible for chronic care management services if it meets the Medicare guidelines. There is no definitive listing of the conditions that qualify according to the criteria; however, the most common ones are:
- Heart disease
- Alzheimer’s disease
- Parkinson’s disease
Increased Support for Chronic Care Management
CMS has been building upon its support for chronic care management reimbursement throughout the years with the help of the following methods:
- In 2017 CMS implemented the complex chronic care management (CCM) CPT codes 99487 and 99489.
- In 2019 CMS adopted the new CCM CPT code 99491. It reimburses physicians for providing thirty minutes of CCM care monthly.
- As part of the final rules for 2020 CMS established payment for an add-on code for CPT 99490 by creating HCPCS code G2058. CMS also introduced two new HCPCS G codes, G2065 and G2064.
- Under the 2021 final rule, CMS introduced an alternative for HCPCS code G2058, CPT 99439.
Checklist for Implementing a Successful CCM Program
This checklist will help ensure that your chronic management plan is addressing the essential aspects required to establish, implement, scaling, and billing for chronic care management (CCM).
Determine Your Goals
It involves identifying patients and their chronic qualifying conditions. It involved the following parameters:
- Draw out your care procedures
- You must determine the number and the type of patients your CCM healthcare team is equipped to handle
- Make sure your protocols and cohorts align with Medicare requirements for CCM
Set up Your Internal Framework
It requires you to ensure your healthcare facility is ready to offer chronic care management (CCM) services.
- Make sure you satisfy CCM requirements set by Medicare to provide CCM
- Acquire the ability to recognize the most qualified CCM patients
- Develop a standardized medical record
- Designate care team members
- Develop the technology infrastructure
Provide Chronic Care Management Services
It covers integrating the chronic care management workflow for your hospital or medical practice. Discussed below are some key elements to consider while setting your CCM workflow:
- Notify patients
- Produce care plan
- Provide care management
- Register and get an informed consent
Get Paid for the Rendered CCM Services
To make sure you get reimbursements for your rendered chronic care management services you are required to meet the requirements for billing. There are six CPT codes for chronic care management that you can bill for CCM services:
- CPT 99490 – billed for the initial 20 minutes of a month to assist in managing chronic health issues with the help of clinical staff and supervised by a physician or another certified health professional.
- CPT 99491 – billed for chronic care management services that last a minimum of 30 minutes per month. For this code, CCM services must be performed by a physician or other certified healthcare professional.
- CPT 99439 – an add-on code to CPT 99490 to provide additional care beyond the 20-minute allotted time. You can use CPT 99439 for each additional 20 minutes spent providing CCM service. Healthcare facilities can use it twice for a maximum of 60 minutes.
- CPT 99437 – an add-on code to CPT 99491 to bill the additional care provided beyond the time allotted (30 minutes). You can use it for an additional 30 minutes of service time. Hospitals and medical practices can charge it only once for a maximum of 60 minutes.
- CPT 99487 – billed for advanced CCM services, which total 60 minutes of medical staff time per month. The time of this CCM service must be guided by a physician or another qualified health professional.
- CPT 99489 – an add-on to CPT 99487, is utilized to provide an additional 30-minute CCM complex service in a calendar month.
This guide presented a checklist to ensure the successful development and integration of a chronic care management program into your practice for an added revenue stream. CareCloud’s Wellness Suite for CCM empowers physicians by supporting practice growth, increasing patient satisfaction, and increasing revenue by handling the CCM program.
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