The new Chronic Care Management Code is creating a lot of buzz among medical practices, both because of the possibility of additional revenue for services that many practices are already providing, and also because practices are trying to figure out exactly how to implement the new program.
The program is promising, especially for primary care practices that have seen reduced income in recent years, because estimates are that potential revenue could exceed $300,000 per year for the average practice according to the Medical Group Management Association (MGMA).
But the chronic care management program also has its challenges, include managing the program, which involves:
- Identifying patients with multiple chronic care conditions
- Managing the patient agreements and care plans
- Tracking care time to insure appropriate billing
CMS has made some parts of the program clear, such as the CPT code and amount of reimbursement (CPT code 99490 for $42.60 per patient per 30-day period), amount of time required to bill (a minimum of 20 minutes), and left other requirements open to interpretation. HealthFusion has made an effort to clarify the program with a free infographic and a free white paper that outline the program requirements.
However, because the program requires explanation for the patient, and a signed agreement with the patient, many practices are still struggling to get this program off the ground—which means a loss of potential revenue, since the chronic care management program went into effect on Jan. 1.
What practices need to do
The agreement that providers must provide to their patients is required to explain:
- That only one practitioner can furnish and be paid for these services
- That the patient can terminate the agreement at any time
- That Medicare co-insurance payments apply
- The types of Chronic Care Management Services that your practice provides
In addition, you will want to explain what terms the patient is agreeing to by signing, as required by Medicare, including:
1. Consenting to the Provider providing CCM services.
2. Acknowledging that only one practitioner can furnish CCM Services to the patient during a thirty (30)-day period.
3. Authorizing electronic communication of the patient’s medical information with other treating providers to facilitate the coordination of care.
4. Acknowledging that the Medicare Co-Insurance amount applies to CCM Services.
5. Recognizing that the patient has the right to stop CCM Services at any time by revoking the Agreement by notifying the practice via a specified method.
In an effort to help practices meet this requirement of the chronic care management coding program, HealthFusion’s CEO, Dr. Seth Flam, has developed a sample patient agreement and a sample patient information sheet that can be adapted by your practice.
Please note that this is a sample document–it is not meant to serve as legal advice. HealthFusion assumes no liability with regard to the use of this document as an agreement between you and your patients. However, we believe that these sample documents can help speed you through the process, and help you cover the required elements.
In addition, MediTouch EHR software provides a new feature that can help you track and manage your chronic care management patients and insure you code and bill appropriately. To see this new feature, request a demo now.
Download the sample patient agreement now, and for additional information, join us for our free webinar, How to Get Paid for the New Chronic Care Management Code.