Chronic care management codingCMS announced a new chronic care management program starting in Jan. 1, 2015, that will allow practices to bill for providing care management to patients with two or more chronic conditions. This new code can be a good source of additional income for many practices, but the program involves some very specific requirements in order for practices to get paid.

Find out how well you understand the requirements for the chronic care management code program now with our quick quiz.

1. Eligible chronic care management patients include:

A. Patients with diabetes, chronic heart conditions and hypertension.
B. Patients over the age of 60 with any chronic condition.
C. Patients with two or more chronic conditions expected to last at least 12 months, or until death, that place the individual at significant risk of death, acute exacerbation/decompensation, or functional decline

2. Only one provider can bill for the chronic care management code in a 30-day period.

A. True
B. False

3. In order to bill for chronic care management, you need to:

A. Be certified for chronic care management
B. Have a verbal agreement with the patient allowing you to bill for chronic care
C. Provide 20 minutes or more of chronic care management services per patient per 30 day billing period

4. You must have a signed agreement with the patient allowing you to bill for these services and detailing:

A. Your fees and a comparison to the fees of other providers
B. Expected outcomes for treatment
C. Cancellation rights, copayments and types of services

5. In order to provide chronic care management under the new code, your practice will need to:

A. Hire a chronic care management coordinator
B. Create a patient-centered care plan document compatible with the patient’s choices and values
C. Focus only on chronic care management

6. Among the requirements of the chronic care management code are:

A. You must manage care transitions between and among health care providers and settings
B. Your practice must be certified as a Patient Centered Medical Home
C. You and a specialist must both bill for each patient

7. You should bill for chronic care management using:

A. An as yet unassigned G-code
B. CPT code 90210
C. CPT code 99490

Answers

1. C Eligible patients include patients with two or more chronic conditions expected to last at least 12 months, or until death, that place the individual at significant risk of death, acute exacerbation/decompensation, or functional decline.

2. A. True – Only one provider can bill for the chronic care management code in a 30-day period.

3. C – In order to bill for chronic care management, you need to provide 20 minutes or more of chronic care management services per patient per 30 day billing period.

4. C You must have a signed agreement with the patient allowing you to bill for these services that details cancellation rights, copayments and types of services.

5. B – In order to provide chronic care management under the new code, your practice will need to create a patient-centered care plan document compatible with the patient’s choices and values and provide either a written or electronic copy to the patient.

6. A – Among the things required under the chronic care management code are that you must manage care transitions between and among health care providers and settings

7. C – You should bill for chronic care management using CPT code 99490. Originally, a G-code was expected to be used, but CMS decided on the CPT code. The fee will be $42.60 per patient per month.

You can learn more about this important program, how to get started and what your software requirements will be, with a:

While the chronic care management code program offers a good opportunity for clinicians to be paid for care they are likely already providing, the program will require significant tracking of the requirements and the provision of care. This tracking will be extremely difficult without software that streamlines the process.

MediTouch is the only EHR software that offers you an in-system feature that makes it easy to manage your chronic care management coding. Request a free online demo of this exciting new feature now.