How to Get Paid for the New Chronic Care Management Code Or How to Increase Your Practice Revenue Without Seeing More Patients
How to Get Paid for the New Chronic Care Management Code or How to Increase Your Practice Revenue Without Seeing More Patients
Under a new Chronic Care Management (CCM) program authorized by CMS and taking effect in 2015, you can bill $41.92 per month for 20 minutes of chronic care activity (non-encounter based follow up care). Annually: $503.04 per year per patient X 100 patients = $50,304 per year* Many of your senior patients likely have two or more chronic conditions, and you are probably already doing this type of care management for your patients with chronic conditions. The good news: now you can get paid for it. Here’s how: Identify fee-for-service Medicare patients with multiple (two or more) chronic conditions expected to last at least 12 months and that represent a significant health risk. Inform the patient that you will be providing them with this service and obtain their signed permission on an agreement that you make part of the medical record. Perform Chronic Care Management services for 20 minutes per 30-day period.
What You Need to Do
Provide 20 minutes or more of chronic care management services per patient per 30 days. Offer patient centered medical services. Note: Your practice does not need to be a certified Patient Centered Medical Home.
What the Patient Agreement Must Explain
That only one practitioner can furnish and be paid for these services, that the patient can terminate the agreement at any time and that Medicare Co-Insurance payments apply.
How to Bill for Chronic Care Management
Medicare will assign a new G-Code for this service – there is no CPT code. Bill the G-Code no more than one time per 30-day period. Do not bill this service for a routine in-person encounter. Be certain that the CCM services (20 minutes of care) were provided and that a patient agreement is on file.
What Your EHR Software Must Do
Have an interface that creates a virtual list of all your patients that have FFS Medicare and at least 2 Chronic Conditions. Narrow that list of patients “real-time” to ones that: Have had activity outside of an in-person or telemedicine encounter with the patient. Have a signed CCM patient agreement incorporated into the medical record. Have a way to create bills with the new G-Code automatically for each 30-day period for every eligible patient. It must track whether the code was already billed during the 30-day period and also remind you to bill the service for eligible patients before the billing period expires. Not every software solution has the ability to make billing for CCM services simple; look for EHR solutions that include a CCM module that assists your practice in optimizing this new revenue opportunity.
What’s the Timeline?
CMS has another 4 months to refine this rule before it goes into effect on Jan. 1, 2015. But we recommend you begin informing your patients now and obtain their signed agreement that they want to participate in this program.
- American Medical Group Association Summary of Key Provisions – Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2015
- Medicare Program Revisions to Payment Policies Under the Physician Fee Schedule – See section K for Chronic Care Management (CCM) Services
- CMS proposes payment for chronic care management in 2015