How to Boost Income With Chronic Care Management


February 26, 2015

In This Article

Payments Now Become Available

The new rule from the Centers for Medicare & Medicaid Services (CMS) allowing reimbursement for chronic care management (CCM) is a huge change that could create much more revenue for many physicians—enabling some practices to get paid for work they're already doing, and others to add services that will increase their revenue and improve patient care.

This means that making phone calls, helping patients fill out insurance forms, consulting with patients about medication over the phone, and taking calls from patients during evenings or weekends may all count toward billable activities, under the CCM code (99490) that went into effect on January 1, 2015.

Matt T. Rosenberg, MD

"The new CCM code allows payment for helping patients during non–face-to-face visits," says Matt T. Rosenberg, MD, family medicine, MidMichigan Health Center, Jackson, Michigan. "Instead of only getting paid when a patient comes in, physicians can provide care management by phone or other means of communication." Qualified activities include performing medication reconciliation and overseeing the patient's self-management of medications; ensuring receipt of all recommended preventive services; and monitoring the patient's condition (physical, mental, and social).

The potential payoff to physicians could be tremendous. Practices can earn $42.60 a month providing care for each patient qualified for CCM. With 500 qualified patients, you could earn an additional $255,600 annually. For practices with 1000 qualified patients, that could be $511,200 in additional annual revenue.

"All the things that you would do for a patient beyond the visit, you can now do, but get reimbursed for many or most of them," says Dr Rosenberg. "The new CMS rule gave us a way to enhance our care and to be able to do more for patients outside of the face-to-face visit. I am very pleased with this. But implementation is going to be a struggle."

One caution: You'll probably have to adapt your current practice workflow to successfully provide and capture billable CCM. Changing your practice to be able to use this code takes work, planning, possible redeployment of some staff, and adaptations of technology. You may need to hire new personnel.

Dr Rosenberg says he is in the process of restructuring his three-physician primary care practice to take advantage of the new CCM code. Medscape will be checking periodically with Dr Rosenberg to get updates about his practice's progress, and to see how he has dealt with some of the challenges that come with this change in practice. Keep reading Medscape for updates.


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