Medicare to Pay for Multiple Chronic Disease Management

December 02, 2013

Starting in 2015, physicians can collect a separate fee from Medicare for managing patients with 2 or more chronic conditions apart from face-to-face visits, according to the final version of the 2014 Medicare physician fee schedule that the government released last week.

The new fee is good news for primary care physicians, but the Centers for Medicare & Medicaid Services (CMS) has yet to spell out all the requirements for earning the extra money. When CMS unveiled the chronic care management (CCM) fee in a draft version of the 2014 fee schedule this summer, it laid out conditions that struck organized medicine as unnecessary and onerous. These included the use of a certified electronic health record (EHR) system, employment of at least one nurse practitioner (NP) or physician assistant (PA), status as a medical home, and offering CCM services on a 24/7 basis.

In the 2014 fee schedule, CMS states that it will address physician objections to the requirements for medical-home status, a certified EHR system, and the employment of NPs and PAs in future regulations. So the government punted on those points of contention.

However, CMS rejected suggestions to relax or phase in its original proposal of making CCM services available 24/7.

"The evolving medical literature on CCM and patient-centered medical homes emphasizes the central importance of members of the care team being available 24/7 to address a patient's acute chronic care needs," CMS stated.

CMS Listens to Physicians, Simplifies Billing Arrangement

The new fee applies to CCM services for patients with multiple chronic conditions expected to persist for at least 12 months or until death, and the conditions must put them "at significant risk of death, acute exacerbation/decompensation, or functional decline." CCM services include treating acute problems such as a fever, drafting a care plan, making referrals to other physicians, and collaborating with home-care agencies.

Technically, Medicare already reimburses physicians for what might qualify as CCM. Office visits and other evaluation and management (E/M) services include physician chores performed before and after the face-to-face visit. However, CMS agrees with organized medicine that in caring for patients with several chronic problems such as diabetes and heart disease, physicians do more work than E/M rates reflect.

The final Medicare fee schedule for 2014 does not specify a dollar amount for the CCM fee. Whatever the fee turns out to be, physicians will bill Medicare for it using a new "G-code," which will apply to 20 minutes of CCM services over 30 days. CMS originally had proposed 2 G-codes, the first covering CCM services that add up to at least 60 minutes over the initial 90 days, and the second code covering at least 60 minutes of additional services over the next 90 days. Organized medicine, however, successfully lobbied CMS to simplify the billing arrangement.

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