Medicare Proposes Dollar Figure for New Chronic-Care Code

July 07, 2014

Medicare would begin to pay physicians $41.92 a month next year for managing a patient with two or more chronic diseases outside of face-to-face office visits, according to a proposed physician fee schedule for 2015 released last week by the Centers for Medicare & Medicaid Services (CMS).

Last year CMS authorized a new billing code for chronic-care management to compensate physicians for tasks such as developing a care plan, referring patients to colleagues, and working with home-care agencies that are inadequately reimbursed under current evaluation and management (E/M) payment codes. CMS scheduled the code to take effect in 2015, but did not assign a dollar amount to it.

The proposed fee schedule for 2015 shows physicians the money, down to the cents. If a medical practice had only 20 Medicare patients who qualified for the new chronic-care management fee, it would gain an extra $10,000.

Physicians would bill Medicare for chronic-care management using a new G code. It would apply to at least 20 minutes of management services over 30 days for a patient whose multiple chronic conditions are expected to last at least 12 months, or until death, and that represent a significant risk for death, functional decline, or acute exacerbation or decompensation. Chronic-care services must be available on a 24/7 basis, but a clinical staff member can provide them at the midnight hour on an "incident-to" billing basis without direct supervision.

In the proposed fee schedule for 2015, CMS backed off from earlier notions to limit the new fee to physicians who employ at least one nurse practitioner or physician assistant, or who operate a medical home. However, CMS continued to make a case for requiring physicians to use an electronic health record (EHR) system that is certified under the agency's meaningful-use incentive program.

A Proposal That Could Reduce Revenue for Surgeons

CMS conceived the new billing code for chronic-care management as a way to support financially beleaguered primary care physicians. Another provision in the Medicare's proposed fee schedule for 2015, however, could reduce revenue for surgeons. CMS wants to stop paying surgeons a set fee for procedures that covers postoperative services — think office visits — during 10-day and 90-day global periods. The agency is proposing that surgeons instead bill postoperative services separately on a piecemeal basis during these timeframes.

What helped prompt this change, CMS explained, were reports from the Office of Inspector General in the US Department of Health & Human Services indicating that most surgeons did not perform as many postoperative services as the global period called for. For example, the fee for a 90-day global period may assume 10 postoperative office visits, but the surgeon may conduct only six.

CMS said it wants to convert both 10-day and 90-day global periods into 0-day periods, which would bundle all preoperative and postoperative care on the day of the surgery together with the operation itself. The 10-day global period would be phased out in 2017, the 90-day global period in 2018.

In a small victory for digital healthcare, CMS also said that it wants to expand the list of reimbursable services delivered via telemedicine to include annual wellness visits, psychoanalysis, psychotherapy, and prolonged E/M services. The agency said this change would improve access to healthcare in rural areas.

The proposed 2015 fee schedule will be published in the Federal Register on July 11. CMS will accept comments from the public through September 5.


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