Getting Paid for
Chronic Care Management
under Medicare in 2015
Kent J. Moore
Senior Strategist for Physician Payment
January 27, 2015
12:30 p.m. (CST)
What We Hope to Do Today
• Identify eligible types of Medicare patients
• Summarize the scope of CCM services
expected by Medicare
• Clarify what is needed to get Medicare
patient agreement before providing and
billing CCM services
• Clarify how to document, code, and bill
Medicare for CCM services
• Provide resources and answer questions
Polling Question
Who’s eligible?
• Patients with multiple (two or more) chronic
conditions
• Conditions are expected to last at least 12
months, or until the death of the patient
• Conditions place the patient at significant risk
of death, acute
exacerbation/decompensation, or functional
decline.
What are the scope
of CCM services?
1. Access to care management services 24
hours a day, 7 days a week
2. Continuity of care
3. Care management for chronic conditions
4. Creation of a patient-centered care plan
document to ensure that care is provided in
a way that is congruent with patient choices
and values
What are the scope of CCM
services? (cont’d)
5. Management of care transitions between and
among health care providers and settings
6. Coordination with home- and community-based
clinical service providers
7. Enhanced opportunities for a patient and any
relevant caregiver to communicate with the
provider regarding the beneficiary’s care
8. Electronic capture and sharing of care plan
information
What is needed in terms of
patient agreement?
You must inform the patient:
• Of the availability of CCM services
• Of the right to stop CCM services at any time
(effective at the end of the calendar month)
• Of the effect of revoking their agreement
• That Medicare will pay only one provider for
these services during a calendar month
What is needed in terms of
patient agreement? (cont’d)
You must:
• obtain a patient’s written agreement to provide
the services (including authorization for the
electronic communication of his or her medical
information with other treating providers)
• document in the patient’s medical record that
you explained and offered all of the CCM
services to the patient and note the patient’s
decision to accept or decline these services.
How do I get paid?
• Document at least 20 minutes of clinical staff
time for the calendar month
• Bill using CPT® code 99490
• Bill at the end of the month
• Collect any deductible or coinsurance from the
patient
• Remember the exceptions
AAFP Resources
• Family Practice Management article http://www.aafp.org/fpm/2015/0100/p7.html
• “Getting Paid” blog http://blogs.aafp.org/fpm/gettingpaid/entry/chroni
c_care_management_lots_of
• Practice Management Help Desk –
http://www.aafp.org/pmhelp
• Staff – Kent Moore and Barbie Hays