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Chronic care management can become an additional revenue stream for practices, but it requires understanding how to use the codes.
Q: Our practice was recently researching the chronic care management services and codes. How can we use these codes to maximize our physician reimbursement?
A: Chronic care management services would help your physician or non-physician practitioners’ (NPP) reimbursement because it is a way to be reimbursed for some of the services they are already providing, and includes the work that the clinical staff is doing as well. The Centers for Medicare and Medicaid Services has established a physician fee schedule amount for facility ($32.89) and non-facility ($42.91) pricing.
The CPT description is:
99490: Chronic Care Management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
Note that chronic care management services of less than 20 minutes in duration, in a calendar month, are not reported separately.
In addition to physicians and NPPs, clinical staff can perform the services acting under general supervision, when incident-to-requirements are met. This is true regardless of whether the individual is an employee, leased employee, or independent contractor of the physician or other practitioner, or the same entity that employs or contracts with the physician or other practitioner and meets any applicable requirements to provide the services, including licensure, imposed by the state in which services are being furnished.
An important change for 2015 is that the services can be provided under general rather than direct supervision. According to 42 CFR 410.32(b)(3)(i), general supervision is when “the procedure or service is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure.”
Additionally, the supervising physician or other practitioner does not have to be in the same office suite as the person providing the service when services are provided outside of normal business hours, and the supervising physician or other practitioner need not be the same physician or other practitioner that determined the care plan.
Educating patients on their rights and responsibilities under chronic care management are important.
Under the program, patients and caregivers have enhanced opportunities to communicate with each other regarding the patient’s care. First, you must inform the patient of the availability of chronic care services and obtain written agreement to provide the services, along with authorization from the patient to share the patient’s medical information with other practitioners through electronic methods.
It’s important to document in the patient’s record that all of the elements of chronic care management were explained to the patient, to note the patient’s decision to accept or decline the service, and that the patient received a copy of the care plan.
It’s important to stress that effective chronic care management can be accomplished only through regular monitoring of the patient’s health status, and through frequent communication and exchanges of information with the patient and the patient’s other healthcare providers.
Physicians who use remote monitoring may count the time spent reviewing data towards the monthly time for chronic care services, but not the total time the patient spends using the monitoring device.
NEXT: Scope of services
To bill successfully for chronic care management services, the following services must be provided.
The provision of 24-hour-a-day, 7-day-a-week access to address the patient’s acute chronic care needs. This means that the patient must be provided with means to make timely contact with healthcare providers in the practice.
Continuity of care
Continuity of care with a designated practitioner or member of the care team with whom the patient is able to get successive routine appointments.
The care plan, part 1
The care plain should include:
The care plan, part 2
The patient-centered care plan document is intended to ensure that care is provided in a way that is congruent with patient’s choices and values. The care plan must cover all patient health issues, and typically includes the following elements:
The management of care transitions is a vital part of chronic care management, and must include:
The answer to the reader’s question was provided by Renee Dowling, a billing and coding consultant with VEI Consulting in Indianapolis, Indiana. Send your billing and coding questions to firstname.lastname@example.org.