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— Craig Endo, MD, Family Medicine
What if you could earn hundreds or even thousands of Medicare dollars each month by billing for care management services your practice already performs today? Sounds too good to be true, right?
It’s all too true for some practices, thanks to a program called Chronic Care Management (CCM). The new CPT code 99490 allows you to submit monthly claims for non-face-to-face services provided to Medicare beneficiaries who have multiple chronic conditions. In 2015, the average reimbursement was $42.60 per patient, adjusted based on geography.
Examples of non-face-to-face services include phone calls and email with patient; time spent coordinating care (by phone or other electronic communication) with other clinicians, facilities, community resources, and caregivers; and time spent on prescription management and medication reconciliation.
In essence, CCM allows your office to become a care coordination hub for ongoing care between visits, generating additional practice revenue for functions already being performed by your team today. We recently profiled one practice collecting $60,000 annually in CCM billings, which the office manager describes as “found money” for the physicians.
How CCM works
Amazing Charts has partnered with Caremerge, a leading care coordination network, to help you deliver the services required for CCM with minimal practice disruption.
The first step is figuring out which patients qualify for CCM. They must be Medicare beneficiaries with multiple (two or more), significant chronic, continuous, or episodic health conditions that are expected to last at least 12 months. Common examples are COPD, diabetes, and hypertension.
You can use the reporting function in your Amazing Charts EHR to search for and create a list of patients who meet the criteria; on average, 80% of Medicare patients will qualify. This is your pool of eligible participants.
To get patients enrolled, use the EHR to send a postal letter or email informing patients of the program and asking them to discuss it during their next visit. Caremerge provides talking points for providers, and verbal consent is noted in Amazing Charts EHR.
The next step is to create a comprehensive care plan for each enrolled patient using Caremerge templates, which is automatically imported into Amazing Charts and attached to the patient’s chart. The Caremerge network provides the care team with 24/7 access to the electronic plan via web browser.
Finally, you or your staff captures care coordination notes with just three clicks using Caremerge’s digital time tracking. A report tells which patients have reached the 20-minute threshold. Submit CCM billing under CPT code 99490 using Amazing Charts EHR just like normal.
How much can you earn? Let’s say you signed up just 200 patients and billed $42 per month for all of them. Your practice’s additional income would be approximately $108,800 per year!
New rules make CCM even better in 2017
Medicare is effectively "doubling down" on its investment in CCM, which can keep people healthier and out of hospitals, while rewarding medical providers who perform this valuable work with new revenue. Here’s a highlight of the changes:
A 3.7% increase in the CPT 99490 payment rate for 2017, to an average of $46.87
A new code, CPT 99487, that addresses the needs of more complex patients. Complex CCM requires 60 minutes of non-face-to-face services per month, with an average payment of $92.66
A new code, CPT GPPP7, that pays you for care plan development, including assessment during a face-to-face service. The projected payment rate for GPPP7 is $63.68.
A reduction in the administrative burden of CCM, most notably removing the requirement for a written consent for patient enrollment, and removing the initiating visit requirement for patients who have been seen within the past year by the practice.
CCM will qualify as a “practice improvement” under the Merit-based Incentive Payment System (MIPS), one of the new MACRA Quality Payment Programs.
Two ways to get started
For do-it-yourselfers and practices with sufficient manpower, we offer Caremerge Provider. You launch and maintain the CCM program. An easy-to-use online platform lets you input all data, run reports, and upload care plans to Amazing Charts. This option requires your staff to make required patient updates.
For those who don’t have the time or resources to manage this program themselves, we offer Caremerge Provider Premium. A telehealth staff (licensed RNs, certified MAs, and Pharmacists) will support your CCM requirements in collaboration with your staff, using remote access to Amazing Charts. This turnkey service provides care plan development, time tracking, and patient education. Although costlier that Caremerge Provider, this option requires no additional staff time.