CMS Chronic Care Management (CCM) Billing · 2016. 5. 11. · CMS Chronic Care Management (CCM)...
Transcript of CMS Chronic Care Management (CCM) Billing · 2016. 5. 11. · CMS Chronic Care Management (CCM)...
M A R Y L A N D L E A R N I N G C O L L A B O R A T I V E
A P R I L 1 4 , 2 0 1 6
J O S E P H K . W E I D N E R , J R . M D , F A A F P
S T O N E R U N F A M I L Y M E D I C I N E
CMS Chronic Care Management (CCM) Billing
CMS Chronic Care Management (CCM) Billing
Topics covered
• Service Requirements • Billing Requirements • Implementation • Stone Run’s Workflow and Billing Processes • Stone Run’s Experience • Marketing/ Promotion to Patients
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
CMS Chronic Care Management (CCM) Billing
Service Requirements
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf
CMS Chronic Care Management (CCM) Billing
Who can perform CCM ?
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Bill under:
Physicians
Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants
Services provided by all the above and clinical staff
CMS Chronic Care Management (CCM) Billing
Who are Clinical Staff?
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
CPT defines a clinical staff member as "a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service; but who does not individually report that professional service."
CMS Chronic Care Management (CCM) Billing
Who are Clinical Staff? - ACP
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Clinical staff – Licensed clinical staff members (including APRN, PA, RN, LSCSW, LPN, clinical pharmacists, and “medical technical assistants” or CMAs) who are directly employed by the clinician (or the clinician’s practice) or a contracted third party and whose CCM services are generally supervised by the clinician, whether provided during or after hours. Thus the “incident to” rules do not necessarily require that the clinician be on the premises providing direct supervision.
CMS Chronic Care Management (CCM) Billing
Billing requirements
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Initiated at a visit. (E/M, AWV, IPPE)
Use and billing through a certified EHR that satisfies the 2011 or 2014 edition of the certification criteria for the EHR Incentive Program
Maintain an comprehensive care plan (documented)
Ensure patient electronic access to care
Facilitate transitions of care
Coordinate care – 20 minutes contact-based (documented)
CMS Chronic Care Management (CCM) Billing
Billing requirements – what counts
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Coordinate care – 20 minutes contact-based (documented)
Phone/ Electronic communication
With patient or individual patient related
In-person visits segregated from other encounters Use modifier -25 if billed on the same day
Not
Clerical/scheduling staff
Time otherwise spent during a visit
Generating reports
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1516.pdf
CMS Chronic Care Management (CCM) Billing
Billing requirements
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
• CPT code 99490
• Written consent (documented) obtained at visit
• Bill only through one clinician per month
• Copayments/Deductibles do apply.
Supplemental insurers that have not paid SRFM:
BCBS Federal (FEP)
Tricare for Life
CMS Chronic Care Management (CCM) Billing
Implementation – (ACP2015) Step 1: Identify the patients
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
EHR generated report:
consider those with 2 or more chronic conditions
review by clinicians
consider focusing on a few problems
Problems: Not predictive of need, death, or decline
Use report to generate who needs a consent form
CMS Chronic Care Management (CCM) Billing
Implementation (ACP 2015) Step 2: Designate personnel and process
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Designate clinician
Clinical staff providing services
Appointment/Encounter codes – schedule
Non-clinical staff to assist with enrollment/consents
Monthly schedule of calls
Invitation to patient – explain above as well as billing
Review participation agreement (in person or via phone)
Record consent in chart https://www.acponline.org/system/files/documents/running_practice/payment_coding/medicare/chronic_care_management_toolkit.pdf
CMS Chronic Care Management (CCM) Billing
Implementation (Stone Run Family Medicine) Step 2: Designate personnel and process
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Designate clinician – preferred provider
Clinical staff providing services
Appointment/Encounter codes – schedule
Non-clinical staff to assist with enrollment/consents
Monthly schedule of calls Encounter notification/point of care driven
Invitation to patient – explain above as well as billing
Review participation agreement (in person or via phone)
Record consent in chart
CMS Chronic Care Management (CCM) Billing
Implementation (Stone Run Family Medicine) Step 2: Designate personnel and process
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Preferred provider already selected in EHR Care managers (LPN/CMA) provide services Encounter type – Care Management Non-clinical staff identifies Medicare patients without consent Front desk staff run EHR generated report at start of every day
indicating which Medicare patients in schedule require a CCM agreement to be signed. Paperclips it to routing slip.
Rooming nurse explains to patient, leaves in room with patient to read and sign, provider clarifies and answer questions.
Consent paper clipped to routing slip – check out staff provide copy for patient at time they check out.
Consent scanned into chart
CMS Chronic Care Management (CCM) Billing
Implementation (Stone Run Family Medicine) Step 2: Designate personnel and process
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
CMS Chronic Care Management (CCM) Billing
Implementation ACP – 2015 next steps
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Create a comprehensive care plan
Provide patient a care plan
Document the time spent
Termination from program
CMS Chronic Care Management (CCM) Billing
Billing processes – Stone Run FM
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Care Managers collect charges Sends charges through EMR clinical module to billing
Also keeps clipboard of patients
Billing reviews end of month. Reconciles with patients on clipboard, notes how long they have time spent.
Billing reconciles with: Transition Care Management (TCM) – CPT 99495 and 99496
Home Healthcare Supervision – HCPCS G0181
Hospice Care Supervision – HCPCS G9182
Certain ESRD services – CPT 90951-90970
CMS Chronic Care Management (CCM) Billing
Patient demographics – Stone Run FM
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Medicare patients n=719 Billed 99490 n=182
CMS Chronic Care Management (CCM) Billing
SRFM monthly totals submitted
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
Average Payment Received
$41.69
CMS Chronic Care Management (CCM) Billing
Number of times patients billed
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine
CMS Chronic Care Management (CCM) Billing
Marketing/ Promotion How to get consent from a patient
MLC 4/14/2016 Joseph K. Weidner, Jr. MD, FAAFP Stone Run Family Medicine