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Chronic Care Management

  • Chronic Care Management Services

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    The Chronic Care Management (CCM) Servicesprogram by the Centers for Medicare & Medicaid Services (CMS) rewards you for the care you and your staff already perform in daily practice.

    Under the Medicare Physician Fee Schedule (PFS), Medicare now pays for non-face-to-face care management services that are provided to Medicare beneficiaries with two or more chronic conditions.

    TMA created this resource center to help you evaluate whether this new opportunity is right for your practice.

    Medicare Pays for Chronic Care Management  

  • Which Patients Are Eligible

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    According to CMS, the eligible patient population is Medicare patients with “multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and for whom the chronic conditions place the patients at significant risk of death, acute exacerbation or decompensation, or functional decline.”

    Patient Eligibility  

  • How Do I Get Started?

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    CCM services are non-face-to-face activities performed by you or your clinical staff to manage and coordinate the care of your patients. To initiate the services, Medicare requires that you first obtain a patient’s informed and written consent* during a face-to-face visit, such as during an initial preventive physician exam, annual wellness visit, or comprehensive evaluation and management visit billed separately. 

    Scope of Service Elements and Requirements  

  • Who Can Furnish and Bill for CCM Services

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    On January 1, 2015, Medicare began paying separately for chronic care management services under the Medicare PFS. The requirement for billing is a minimum of 20 minutes of qualifying care per patient per calendar month. Check with your other payers to see if they, too, provide payment for CCM services.

    Physician and Practitioner Eligibility  

  • What Payment Amount Should I Expect?

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    Payment in 2015 under the Medicare PFS for CPT code 99490 is about $42* per calendar month, and standard coinsurance and deductibles apply. Patients are subject to a copay of approximately $8 or 20 percent each time you bill the service.

    Payment Details  

  • What Are the Potential Challenges and Benefits?

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    The potential challenges and benefits may include, but are not limited to the following:

    Physician Challenges and Benefits  

  • Where Can I Find Resources and Tools?

    Centers for Medicare & Medicaid Services
    CMS Chronic Care Management Services Fact Sheet
    Payment of Chronic Care Management Services Under CY 2015 Medicare PFS
    Chronic Care Management Services Frequently Asked Questions

    American College of Physicians
    ACP Chronic Care Management Toolkit: What Practices Need to Do to Implement and Bill CCM Codes
    Includes a general overview with billing and documentation requirements, step-by-step implementation process, sample log, sample consent form, and sample termination form.

    American Academy of Family Physicians
    AAFP Chronic Care Management Toolkit
    Includes an introduction with key billing requirements, letter to patients, patient agreement form, patient-centered care plan, a spreadsheet for tracking purposes, answers to frequently asked questions, and a free on-demand webinar open to the public.

    Texas Primary Care and Health Home Summit
    Texas Primary Care and Health Home Summit: Resources
    Includes a risk-stratified care management and coordination tool and three sample consent forms

  • Can TMA Help Me With CCM Services?

    While many physician practices are likely to be interested in the enhanced revenue and patient care improvements from the Medicare Chronic Care Management (CCM) program, they might lack the operational efficiencies, technological infrastructure, and ability to handle the additional workload. Practices can find the help they need through TMA Practice Consulting.

    To find more information about implementing a CCM program in your practice, sign up for one of the TMA Medicare seminars in November and December 2015 or the new webinar series coming this fall, which will explain CCM for accountable care organizations. Registration will be available through the TMA Education Center.

    In addition, TMA PracticeEdge is developing a turnkey solution, including patient eligibility identification, structured data recording, and care management services.

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