Chronic Care Management: Making Sense of It All
Marissa Rogers, DO Genesys Regional Medical Center
Goals/ObjectivesIdentify what Chronic Care Management Services are and if/when to utilize them in your practice
Familiarize the learner with CMS requirements prior to implementation of CCM plans and requirements once the plan is in place
Identify scope of practice for CCM services
Provide important take away notes that are unique to CCM Services
What are Chronic Care Management Services?
Starting in 2015, Medicare began paying separately for non-face-to-face coordination services
Medicare Fee For Service ONLY (original Medicare)
CMS recognizes care management as a critical component of primary care, resulting in better health outcomes and reduced healthcare spending
Who is Eligible for Chronic Care Management?
Patients with 2 or more chronic conditions that are expected to last at least 12 months, OR until the death of the patient
Chronic Conditions put patient at significant risk of death, acute exacerbation/decline, or functional decline
Comprehensive Care Plan established, implemented, revised, or monitored
Conditions may include, but are not limited to Alzheimers and related dementia
Arthritis (OA/RA)
Asthma
A-Fib
Autism Spectrum Disorders
Cancer
COPD
Depression
DM
Heart Failure
HTN
Ischemic Heart Disease
Osteoporosis
What is Required of the Clinician or Clinical Staff?
At least 20 MINUTES of documented clinical staff time per MONTH, directed by the Physician or other qualified healthcare professional
CPT Code 99490
This can be billed by ONLY ONE clinician per month
Who Can Bill for CCM?Eligible Practitioners include:
Physicians
Certified Nurse Midwives
Clinical Nurse Specialists
Nurse Practitioners
Physician Assistants
Who is Considered Clinical Staff?
APRN (Advanced Practice Registered Nurse)
LPN
Certified MA
PA
Clinical Pharmacists
LSCSW
RN
Important Note on Clinical Staff
To be considered ‘Clinical Staff’, they must be:
Employed by the clinician (or practice), or contracted third party
All CCM Services MUST be generally supervised by the clinician, whether provided during or after hours
Requirements cont…
The Billing Practitioner must complete ONE of the following prior to billing CCM code and initiates CCM plan at time of visit/exam
Comprehensive E/M visit
Annual Wellness Visit
Initial Preventative Physical Exam (IPPE)
Case 68 year old female, S.J., comes in for her Annual Medicare Wellness Exam
You note that her Active Problem List includes:
DM 2, insulin dependent
HTN
Depression/Anxiety
OA of her R knee
Is Your Patient Eligible???
Your front office staff points out to you that this patient has Medicare Fee for Service …because they know you are trying to provide CCM Services to your patient population
YES! She would be a great
patient for CCM Services…but NOW
WHAT????!!
The Hard Part…
Implementing the CCM Plan can get a little complex at this stage
There are a few things you need in place PRIOR to implementation in your practice
First…Decide who will be primarily handling the telephonic and electronic portions of the CCM plan- do you have a CMA, or an RN to help?
How will they document the 20 minutes each month?
If you plan to use another clinician to provide call coverage, do they have access to the CCM plan and can they document if they end up providing non-face-to-face care?
Second…Any participating patients MUST have a written signed consent
Medicare does NOT have a universal consent form available, however, there are examples online that can be accessed that have been put into tool kits by FM organizations
http://www.aafp.org/fpm/2015/0100/fpm20150100p7-rt2.pdf
What does the Consent Consist of?
The Consent must explain the services and agreement of accepting the services provided
Must include authorization for electronic communication of his/her medical information with other treating providers as part of care coordination
Document in the patient record that services were explained and if the patient declined or accepted
The patient needs to be aware that they can stop CCM services at any time (effective at end of month)
Inform patient that only one provider can furnish and bill for services per month
Now What?
You now have your patient consented to CCM services, and your plan for who will be making the non-face-to-face contact with your patient, so what is required of you to bill for this on a monthly basis?
Plan of CareThe Plan should include, but is not limited to…
Problem List
Expected Outcome and Prognosis
Measurable Treatment Goals
Symptom Management
Planned Interventions
Medication Management
Community/Social Services Ordered
Individuals Responsible for Interventions
Scope of Services
8 Elements define the Scope:
1. 24/7 access- you must provide the patient with the means of access to care for any acute or urgent concerns in regards to their chronic care needs
2. Continuity of Care- you must provide the patient with the ability to follow up with the same designated clinician for routine care
3. Care Management for Chronic Conditions- this includes assessment of medical, functional, and psychosocial needs; making sure the patient is receiving preventative services at the correct times; med rec; and oversight of patients’ self management of meds
4. Create a Patient-Centered Care Plan- one that ensures the plan is congruent with patient choices and values
FPM has created a document in pdf form that can be used to help you (either use the document as is, or can be a template for you to create one)
http://www.aafp.org/fpm/2015/0100/fpm20150100p7-rt1.pdf
5. Manage health care transitions between and among health care providers and settings
Referrals
Follow Up visits after ER visit
Follow Up visits after hospitalization, skilled nursing facility, or other health care facility
Requires electronic exchange of clinical summary- it can’t be faxed
6. Coordinate with home and community-based clinical service providers
Ensures support of the patient’s psychosocial and functional needs
7. Enhanced opportunities for a patient and any relevant caregiver to communicate with the provider regarding the beneficiary’s care
this includes other non-face-to-face communication outside of using the telephone: secure messaging, internet, etc
8. Electronic Capture and Sharing of Care Plan Information
Any provider whose care time will count towards the 20 min of non-face-to-face care will need 24/7 access to the care plan
It must also be shared with any other providers, as appropriate, who are furnishing care for the beneficiary (fax not acceptable)
Important Notes to Remember
If you don’t meet 20 minutes of documented care coordination/planning, you can’t bill CCM services that month
The minutes do NOT ‘rollover’ once the month ends
Reimbursement is approx 42$ per patient for CCM code
Important Notes Cont…Be aware and be sure your patient knows that co-pays and deductibles DO apply to CCM services
Any minutes spent on CCM services that result in an office visit due to that phone call or secure messaging are no longer counted as CCM services- they are now considered to be part of the office visit
CCM Services do not include clinician time spent on refilling meds, completing Prior Authorizations, etc
Important Notes, cont…
CCM Services cannot be billed for in the same month if you bill Transition of Care Services (99495-99496)
CCM Services cannot be billed for in the same month if you bill Home Health Care Supervision/Hospice Care Supervision (G0181/G0182)
CCM Services cannot be billed for in the same month if you bill for certain ESRD services (90951-90970)
Referenceshttp://www.aafp.org/fpm/2015/0100/p7.html
https://www.acponline.org/system/files/documents/running_practice/payment_coding/medicare/chronic_care_management_toolkit.pdf
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf
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