Need Help Implementing Chronic Care Management Services?

New CMS, HRSA Initiative Offers Physicians Free Resources

March 24, 2017 03:49 pm News Staff

CMS recently announced the launch of a new educational initiative aimed at raising awareness of the benefits chronic care management (CCM) services can bring to Medicare patients.

[Book with title chronic care management on a table]

The initiative, dubbed Connected Care,(www.cms.gov) also offers family physicians and other health care professionals the support they need to implement chronic care management programs in their practices.

According to a March 15 CMS press release,(www.cms.gov) the nationwide effort -- jointly developed by CMS' Office of Minority Health and the Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy -- features a special focus on racial and ethnic minorities and patients in rural communities.

"This important initiative builds on our efforts to help providers care for patients with multiple chronic conditions," said Cara James, Ph.D., director of CMS' Office of Minority Health. CMS' work with HRSA will help the agency reach vulnerable populations, she added.

Story Highlights
  • CMS and the Health Resources and Services Administration recently launched an initiative that aims to help physicians implement chronic care management services in their practices.
  • The initiative offers physicians a multitude of free resources, including patient education pieces.
  • CMS noted a special focus on making the services available to racial and ethnic minorities and to patients in rural communities.

Two-thirds of Medicare patients have two or more chronic conditions; another one-third have four or more, the agency noted in its release.

According to CMS, many health care professionals already are providing chronic care management for their patients, which the agency defines as non-face-to-face services that include coordinating with other health care professionals and reviewing test results.

However, the agency suggested that many of those same physicians may not be aware of the specific codes that now allow for separate payment for these services through Medicare Part B.

"We are thrilled to be joining CMS to educate health care professionals and patients about the value of chronic care management with the goal of improving overall patient care for millions of Americans and reducing overall health care costs," said Tom Morris, associate administrator of HRSA's Federal Office of Rural Health Policy.

As part of the initiative, CMS is offering physicians a variety of resources free of charge.

Among those materials are a fact sheet about CCM services, an FAQ about how to bill Medicare for CCM services, links to CMS webinars and patient education posters in both English and Spanish that are designed for placement in medical offices.

Barbie Hays, C.P.C., the AAFP's coding and compliance strategist, told AAFP News that the patient education component is particularly important given that family physicians have reported some degree of pushback from patients.

"This resistance primarily revolves around the approximately $8 to $18 copays for which patients may be responsible," said Hays.

She noted that CMS' 2017 updates to the Medicare physician fee schedule removed the original signed-consent requirement. "A verbal consent between the physician and patient must now be recorded in the patient's chart," said Hays.

A short refresher course on the whole CCM issue may be in order.

Physicians might remember that CPT code 99490 was implemented in January 2015 and allows for the billing of at least 20 minutes of non-face-to-face clinical staff time each month -- directed by a physician or another qualified health care professional -- for the specific purpose of coordinating care for patients with two more serious chronic conditions that are expected to last at least 12 months.

Since then, in response to feedback from the AAFP and other stakeholders across the country, CMS updated the rules pertaining to chronic care management in the 2017 Medicare physician fee schedule(s3.amazonaws.com) that took effect on Jan. 1.

Those revisions direct CMS to pay for an existing code -- CPT code 99487 -- that allows physicians to bill for complex chronic care management when certain conditions are met, including 60 minutes of clinical staff time.

Also in 2017, CPT code 99489 was introduced as an "add-on" code for each additional 30 minutes of clinical staff time specifically spent on managing complex chronic care.

CMS also added Healthcare Common Procedure Coding System (HCPCS) code G0506 as an add-on code to an initial visit. This code allows physicians to bill for their time providing a patient with a comprehensive assessment and care planning for any type of evaluation and management visit.

Because chronic care management is a vital component of the care family physicians offer their patients, the AAFP also has created a variety of resources to ensure that members have all the information they need at their fingertips.

Related AAFP News Coverage
Chronic Care Management
CMS Clarifies Use of CCM Code in Medicare Advantage Plans

(4/14/2015)

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In the Trenches Blog: AAFP's Advocacy Efforts Paved Way for New Care Management Code
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