Although Medicare began paying for chronic care management (CCM) services in 2016, the Centers for Medicare and Medicaid Services (CMS) reports that many practices are not taking advantage of the new coverage, even after more than a year. And if you’re not billing this service for those who are likely your sickest patients, you’re losing out on significant reimbursement.

When your practitioner provides CCM services, he manages a patient’s medical, functional and psychosocial needs. This includes spending at least 20 minutes each month on things like medication management and coordinating other therapeutic services. Your office also becomes the point of contact for patients and their caregivers not only through telephone access, but also via secure messaging, Internet or other non-face-to-face consultation. Your office has to be able to provide these services any time of day or night to qualify for CCM reimbursement (either via your in-house staff or a third party).

If your clinician(s) documents the service correctly and you properly apply CCM code 99490, Medicare will reimburse your office for this time at a rate of roughly $42 for each patient per 30-day period in 2017. Although this doesn’t sound like much, it can quickly add up. For instance, if you provide CCM services to 100 Medicare patients each month, and code these services based on CCM guidelines, you could bring in $42,000 extra per year. Also, you can bill for other services in addition to CCM, which means this reimbursement is on top of what you normally receive.

For example, an elderly patient with multiple illnesses and dementia bound for a nursing home can have as many as 10 different doctors — half of whom may be prescribing medications. Patients and their families find dealing with so many different specialists bewildering and stressful. At the same time, CMS believes that its payers spend more than two-thirds of Medicare dollars on these patients.

CCM is meant to address this situation by helping to:

• Manage these different providers’ care.
• Ensure all medication prescribed makes sense for the patient when taken together.
• Reduce the expense of uncoordinated services by paying one primary care physician to serve as the point of contact for all the patient’s care.

So if you’ve chalked up CCM as more trouble than it’s worth, you might want to reconsider what these services could mean for your practice. In many cases, you may find that you’re already performing this level of service, and you should be reimbursed accordingly.

Take Aways

• If you’re providing at least 20 minutes of chronic care management services, you should be reporting them with 99490.
• Patients and their families prefer to have a single point of contact for their care, and this could be a significant income for your practice.
• CCM can improve patient care and safety by coordinating the efforts of multiple providers and reducing duplicated or contradictory services.