How to Boost Income With Chronic Care Management


February 26, 2015

In This Article

What's Hard About Preparing to Do CCM?

The Current Procedural Terminology CCM code, 99490, has several requirements, each with its own stipulations:

Beneficiary's written consent;

Five specified capabilities; and

20 or more minutes per month of non–face-to-face care management services.

"You need to have the appropriate infrastructure in order to make this work," says Dr Rosenberg. "And everything you do for this code needs to be documented for the insurance companies. In some ways, what we're doing is what some concierge practices have done: They charge a fee to be able to afford the infrastructure to provide all the patient services. The changes we're making in the practice are an attempt to provide that."

"The CCM rule is really honing in on what's right to do for patients," adds Dr Rosenberg. "How well we can implement this, I don't know. We are going to do our best!"

The Medicare CCM program does not require that the practice is attesting for meaningful use (which Dr Rosenberg's practice is not), but the practice does need to use an electronic health record (EHR). "The EHR is an important part of it," says Dr Rosenberg. "We do e-prescribing. We have created a template on the EHR that we use for CCM."

The five capabilities that CMS requires a provider to have to bill for CCM are:

  1. Use a certified EHR for specified purposes

  2. Maintain an electronic care plan.

  3. Ensure beneficiary access to care.

  4. Facilitate transitions of care.

  5. Coordinate care.

First Challenge: Identifying the Right Patient

Not every Medicare patient is eligible for the CCM program. "We need to identify patients with two or more chronic diseases, which is actually a large percentage of the Medicare population," says Dr Rosenberg. "So we are having this conversation with every Medicare patient in our practice."

Second Challenge: That Patient Has to Provide Consent

Each eligible patient has to sign a consent form to participate in this program. There is no retroactive billing for services performed before the signed consent is established, so physicians who are interested in this program should try to obtain consent from as many patients as they can, as soon as possible, advises Dr Rosenberg.

"To obtain patients' consent, I explain what our practice is going to do for them and what they can expect," says Dr Rosenberg. "We explain that chronic care management will be billed through Medicare and the patient can revoke this agreement at any time. I do tell them that this is a chance for us to get reimbursed for the work we do during the year."


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