Improving Practice Revenues by Offering Chronic Care Management

Chronic care management is the need of the hour, not just from the perspective of value-based healthcare but also due to the rising number of people with chronic conditions. Did you know that the number of people with chronic health conditions in the U.S. will reach 171 million by 2030? With an estimated population size of 356 million by 2030, about 48 percent of the population will potentially need chronic care management.

What is Medicare Chronic Care Management?

Introduced by Medicare in 2015, chronic care management or CCM is part of the connected care initiative that incentivizes medical practices for extending care services beyond in-practice visits. A patient eligible for CCM has more than one chronic medical condition (such as diabetes, arthritis, depression, asthma, addiction, and heart failure) that significantly impacts the quality of life for the person and may pose a risk to life. CCM is offered through non-face-to-face services and is expected to last at least 12 months or until the end of life.

Under CCM, a medical practice is required to set up a comprehensive care plan, agree on measurable patient-care goals, track the progress of the patient through periodic reviews and revise the care plan as applicable. The CCM services can be delivered directly by the physician or a non-physician practitioner under the guidance of the billing physician.

Scope of CCM Billing

The reimbursable CCM services under Medicare’s chronic care management include the following-

• A minimum of twenty minutes of CCM services per month.
• The time spent by a healthcare professional to create a customized care plan (for the patient) with measurable treatment goals.
• Coordination done for the patient for medications, consultations with medical specialists, lab work, other hospitals, etc.
• Round-the-clock access to medical assistance by a healthcare professional or clinical staff.
• Consultations with medical experts for meeting the healthcare goals of the patient.
• Transitional care management, which includes coordination with other providers to ensure continuity of care.

CCM Billing Codes

Here is a list of CCM billing codes.

Benefits and Challenges of Implementing Chronic Care Management

When launched in 2015, the expectation was that many medical practices would opt for the service, given the potential for higher revenues. A 2015 study published in the Annals of Internal Medicine indicated that chronic care management billings under the CPT code 99490 could add $75000 in annual revenues even if 50 percent of eligible patients enrolled. Another estimate by Becker’s Hospital Review puts the annual CCM benefit at $139,104 in revenue per year.

However, the complicated terms and conditions (refer to this 2019 FAQ by CMS on CCM) have meant that many medical practices did not opt for the service. The detailed CCM documentation of patient care (including all communications with the client via email, text, and phone) is a dissuading factor for primary care physicians. In addition, only practices that use CMS-certified EHR technology can bill for CCM service. Replacing the existing EHR system is a substantial financial commitment, especially for smaller medical practices.

CMS has taken some cognizance and has, over the years, evolved the program. For instance, in 2017, CMS added additional coverage for reimbursing physicians for additional care services offered for a patient beyond the planned CCM care. Before 2017, medical practices required written consent from participating CCM patients. That has been done away with, and you can now take verbal permission from the beneficiary. As of January 2018, FQHCs and RHCs are acceptable locations to bill for CCM services.

Overall, as healthcare reimbursements continue to move in the direction of value-based models, CCM offers a triple benefit for medical practices. It will improve revenues and improve the quality of care while reducing the cost for patients. As a medical practice owner, you must make a concerted effort to offer CCM for patients with chronic conditions.

Importance of Chronic Care Management for Gastroenterology Patients

The long-term management of chronic gastroenterology conditions requires a team of experts – gastroenterologists, nurses, surgeons, GPs, pharmacists, psychologists, and dieticians. Yet, patients with chronic conditions such as IBD (inflammatory bowel disease), IBS (irritable bowel disease), and coeliac disease (Ced) are rarely able to access a multi-disciplinary team that is working together. The problem is compounded by a lack of communication between the primary care and specialized care providers.

Research has shown that the gaps in delivering quality care (for IBD patients and other GI conditions) can be addressed if the primary care providers (GPs and nurses) play a more active role in managing the disease. While it is important to have specialist care, general physician practices can contribute via chronic care management. For example, by ensuring that the patient is adhering to the prescribed course of therapy and medication and by giving advice on smoking cessation, vaccinations, travel, and cancer screenings.

Tips to Implement CCM

Since securing patient agreement can be a significant obstacle, it is imperative that you develop an ‘elevator speech’ that quickly summarizes the benefit of the service for your patients. Direct communication between your physicians and patients will be instrumental in securing the initial consent. You must ensure that the medical and billing staff understand the CCM documentation requirements. Also, check out these chronic care management implementation resources –

• “Connecting the Dots” Animated Video for Patients– Use this animated video in English and Spanish to help explain the benefits of CCM services to your patients.
• CMS Chronic Care Management Fact Sheet

Do you want to implement CCM in your medical practice? PracticeForces currently services many primary care physicians and multispecialty (especially GI group practices) for CCM billing. As a CMS rule you can’t bill patient for CCM services. Therefore, you must ensure that your CCM medical billing is comprehensive and as per provider guidelines. Call us at 727 499-0355 or send us a message today for information on chronic care management billing.