Medical providers have often expressed frustration over the fact that much of the care they provider their patients occurred between billable patient office visits. In response to these types of complaints, Medicare and private insurers and have progressively made non-face-to-face interactions between patient and provider increasingly billable over the last few years.

Chronic Care Management (CCM) is a Medicare program designed to connect patients and providers between traditional office visits. Providers can bill for CCM each calendar month when at least 20 minutes of clinical staff time was spent on care coordination for an eligible patient. Reimbursement for CCM runs around $40 per month at the 20 minute level, and then goes up from there.

Medicare heavily promotes the use of CCM services, going so far as sending postcards to providers advertising the fact that they pay for it. Medicare estimates that two thirds of the Medicare population has two or more chronic conditions, and that proper management of those conditions significantly improves patients health and satisfaction.

The Physician’s Guide to Chronic Care Management

While Medicare’s Chronic Care Management is a great program, it has not been without its hiccups. When first launched, there was a general lack of information to providers about what exactly they had to do in order to bill for Chronic Care Management. Once the complexity and specificity of the requirements became more known, many providers were reluctant to provide Chronic Care Management because they believed the reimbursement was not worth the cost of complying to the billing requirements.

Medicare has been addressing these issues since the launch of Chronic Care Management in 2015. They have eased many of the requirements, increased the amount of activities that can qualify as CCM time, and increased the reimbursement for more complex patients.

The advent of CCM software has also eased the barriers to operating a Chronic Care Management program. Good software can allow a provider to focus the care aspects of CCM while letting the software make sure everything is compliant and billable. (Excuse the shameless link)

Reimbursement for CCM (from CMS.gov):

  • CCM Initiating Visit (AWV, IPPE, TCM or Other Face-to-Face E/M. $44-$209)
  • CPT 99490 still effective for Non-Complex CCM ($43)
  • CPT 99487 (Complex CCM, $94)
  • CPT 99489 (Complex CCM Add-On, $47)
  • G0506 (Add-On Code to CCM Initiating Visit, $64)
  • CPT 99358 (Prolonged evaluation & management, the first hour,$113 )
  • CPT 99359 (Prolonged evaluation and management, the next 30 minutes. $55)

Almost two thirds of Medicare beneficiaries have more than one chronic condition, yet not near that many beneficiaries are currently enrolled in the CCM program despite its clear benefits. That is a lot of missed health benefits and lost possible revenue.

The Prevounce Portal makes Chronic Care Management easy and efficient. The Prevounce CCM care plan wizard asks intuitive, evidence based questions that help you quickly identify goals and generate a comprehensive care plan that is compliant with Medicare regulations. Our other services also seamlessly integrate with our CCM module, allowing offices to not only collect CCM revenue but also to use their CCM and wellness efforts to increase their Medicare MACRA and MIPS modifier.

CCM on its own can be very rewarding. Add Prevounce to the equation, and you will get increase revenue, healthier patients, and worry-free regulatory compliance. Check us out at www.prevounce.com today to schedule a demonstration or try us out today.