April 16, 2021

5 min read

Role of Medicare Chronic Care Management in Hypertension Management

It's no secret that hypertension is one of the most widespread chronic diseases affecting Americans today. The average American diet and sedate lifestyle have begun to create confounding and devastating effects as Americans age into older adulthood. As more Americans are diagnosed with hypertension, it's important that we fully understand the true cost of this often-silent condition and constructively address ways to create a significant impact on mitigating this gateway chronic disease via solutions such as chronic care management (CCM) and remote patient monitoring (RPM).

The Hypertensive Impact

A healthy circulatory system is vital to our overall health and wellness, but when blood pressure begins to rise on a consistent basis and too much force starts pushing against fragile blood vessel walls, the chronic condition known as hypertension begins to take hold. More Americans than ever before are falling victim to this often-silent chronic condition which, in turn, leads to increasing rates of more serious secondary health issues, such as heart attacks, strokes, and even heart failure. Even more concerning is the fact that more than 100 million Americans have hypertension. Of the Americans who have been diagnosed with hypertension, only about one-quarter have the condition under control. High blood pressure was a primary or contributing cause of death for nearly half a million people in the United States in 2018. High blood pressure costs the United States about $131 billion annually, making it a very expensive adversary.

Since hypertension does not always present with obvious symptoms, it often leads patients to believe it is less harmful than it actually is, aggressive treatment isn't necessary, and help from their practitioner isn't required. However, the opposite is true: the earlier hypertension is recognized and treated, the better the long-term outcome will be for the patient.

Creative Solutions: Medicare Chronic Care Management

In recent years, many practitioners have been encouraging their patients to self-monitor symptoms of hypertension from home. While regular checks in the office are necessary, many patients have been sent home with a blood pressure monitor, logbook for tracking, and prescription medications. While this approach has helped some patients gain a better understanding and control over their hypertension, it didn't illicit quick reactions for acute exacerbations nor offer the direct oversight or support that many people need to stay on track with hypertension monitoring and management. Further, many patients would not comply with the at-home tracking or report information back to their provider accurately.

Practitioners and their clinical teams also found themselves spending countless hours coaching their patients outside of normal office visits — time spent that wasn't reimbursable by most payers or Medicare. From there, the concept of chronic care management (CCM) evolved and grew into what we have today: quality and supportive wrap-around care for patients and fairer compensation for practitioners.

In 2015, Medicare began paying practitioners for the chronic care management services provided to those Medicare beneficiaries with two or more qualifying diagnoses. This rule change opened the door to better care for patients and allowed practitioners to be better compensated for the time they had already been spending on patient care. More recently, CCM for Medicare patients was expanded further, adding new CPT codes to include complex chronic care management and principal care management.

Coverage of Chronic Care Management

For a practitioner to receive Medicare reimbursement for the provision of chronic care management services, the following codes must be used and specified criteria met:

CPT 99490

Used for non-complex chronic care management services and covers the first 20 minutes of time per calendar month provided to the patient by clinical staff members. This time must be spent coordinating the patient's care, providing direct patient support, and/or establishing, implementing, or revising the patient's care plan.

CPT 99439

Used for each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified healthcare professional.

CPT 99487

Used for the provision of complex chronic care management, this code recognizes that at least 60 minutes of clinical staff time — directed by a physician — per calendar month was used to provide services to the patient and involved moderate to high-complexity medical decision-making.

CPT 99491

This code is to be billed with at least 30 minutes of chronic care management services were provided personally by the physician or other qualified healthcare professional.

These are just the most common CCM codes. Here you can find information on all CCM billing and coding requirements.

Taking CCM Further: Adding Remote Patient Monitoring

Medicare further empowered providers to provide hypertension management in 2019 when it began covering remote physiological monitoring, also known as remote patient monitoring (RPM). When integrated into a Medicare chronic care management program, RPM can offer real-time support to patients and provide the healthcare team with more accurate and current information concerning patient health. For hypertensive patients, this close, ongoing support often contributes to better-controlled symptoms and more convenient care. According to the American Heart Association, patients with hypertension who participate in an RPM program experience a substantive and positive impact on both their systolic and diastolic blood pressure.

For patients diagnosed with hypertension, remote patient monitoring looks like the more traditional concept of home monitoring of blood pressure, but the RPM concept utilizes connected technology to send real-time updates to the patient's healthcare team. When the device is designed with patient ease of use in mind (e.g., automatic 4G wireless sync, single button operation, pre-configured), user error can be mitigated, and more accurate results can be recorded. If patients experience an acute exacerbation, the healthcare team can intervene quickly, hopefully avoiding the need for an emergency room visit or hospitalization.

Chronic care management has a higher reimbursement and is billed differently when the program also incorporates remote monitoring. You can find more information on RPM billing and coding requirements here.

The benefits of combining chronic care management and remote patient monitoring go further than improving patient health outcomes. The combination also offers practitioners a lucrative way to generate practice income while providing patients with optimal care from the comfort and safety of their home. When pairing these two services with intuitive, smart technology, practitioners can save time and allocate staff more efficiently, leading to improved productivity, better patient care, and a healthier bottom line.

Read the Guide: Building a Successful Chronic Care Management Program

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