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Chronic Care Management Program Explained

CCM Program Consultants in Hackensack, New Jersey

Why the Need for the Chronic Care Management Program?

Medicare’s most expensive part is shown in the care given to chronically ill patients. This shows the need for CCM. The studies are done, and the facts are very clear as presented below:

93% of spending to patients with multiple chronic conditions

91% of prescriptions filled

81% of admissions in the hospitals

75% of physician visits

171 million Americans estimated to have one or more chronic condition by 2030

What is Chronic Care Management (CCM) CPT 99490?

Overview
In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) through American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare patients with multiple chronic conditions.

CPT 99490
Medicare defines CPT 99490 as chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, 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/decompensation, or functional decline
  • Comprehensive care plan established, implemented, revised, or monitored

CPT 99487 and 99489

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/decompensation, 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 healthcare professional, per calendar month

CPT 99489
Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure)

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes added to the first 60 minutes of complex CCM services during a calendar month.

Examples of Chronic Conditions

The following examples of chronic conditions are updates from Centers for Medicare & Medicaid Services (CMS) made for Department of Health and Human Services and effective on January 1, 2017:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS

Who Can Bill the 99490, 99487, 99489 Code?

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

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants

Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or noncomplex CCM for a given patient for the month (not both).

NOTE: CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care.

Why Choose Phoenix Healthcare Advisors, LLC as your Care Management Service Partner

CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner),

subject to applicable State law, licensure, and scope of practice. The clinical staff members are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.

At Phoenix Healthcare Advisors, LLC, we provide up-to-date resources and tools needed to participate in the CCM Program. We ensure that you will receive financial coverage as fast as possible while enhancing the health of your chronically ill patients under Medicare. Choose us to be your partners today as we make things easy for you and your staff members.

What are the Benefits of CCM?

Benefits for Providers

  • Initiating Visit
  • Structured Recording of Patient Information
  • Additional CCM Revenue
  • Increased In-Office Encounter Revenue
  • Comprehensive Care Plan
  • Improved Quality Measures
  • Reduced Burden of Managing Medicare Patients
  • Improved Work/Life Balance
  • Patient Satisfaction
  • Improve your MACRA/MIPS Scorecard
  • Decreased Hospital Admissions/Readmissions

Benefits for Patients

  • Decreased ER Visits, Hospitalizations & Unnecessary Procedures
  • Comprehensive Care Management
  • Reinforcement of Healthy Behaviors
  • Improved Quality of Life
  • Patient Adherence & Patient Literacy
  • 24/7 Access & Continuity of Care
  • Management of Care Transitions
  • Home- and Community-Based Care Coordination
  • Enhanced Communication Opportunities
What are the Challenges to Value-based Care?

Various challenges, like the list below, have prevented health care providers from participating in the Chronic Care Management Program and other value-based care initiatives.

  • Burden of Time
  • Managing Internal Resources
  • Protecting (ePHI)
  • Cost of Resources
  • Liability
  • Compliance
  • Third-Party Software
  • Documenting Appropriately
  • Fear of Penalties
  • Hiring the Right Resources

What are Outcomes of Providing CCM Services?

Active engagement between the provider and the patient with a comprehensive care plan is the most valuable result of providing CCM services. The specific outcomes are listed below:

  • Developed Delivery System Through Care Coordination
  • Enhanced Self-Management Support
  • Patient-Centered Care Plan
  • Shared Comprehensive Plan for Problem-Solving
  • Improved Standard Measures and Patient Satisfaction
  • Continued Care Through Quality Evaluation

Contact Information

277 Prospect AvenueHackensack, New Jersey

855-544-0475

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