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Renae Rossow
Renae Rossow
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Chronic Care Management: The Updates for 2017

Chronic Care Management: The Updates for 2017

Based on the latest statics, three of every 4 Americans age 65 and older have multiple chronic conditions. Because of this, along with our aging population as a whole, chronic care management (CCM) services have become vital to improving health outcomes of our senior citizens while reducing the rising healthcare costs overall. In 2015 Medicare began reimbursing providers for providing CCM Services under CPT code 99490. 

By 2017 CMS realized that there were both non-complex and complex chronic care management services that were provided. Because of this, the time that is required of a practitioner to provide these services could vary greatly. To address this issue, CMS added two new codes for what they now call Complex CCM Services. Additionally, they added new CPT codes for the initiating visit. Here is how all five CCM codes are now defined:

  1. CCM (CPT 99490):  Requires 20 minutes or more of clinical staff time in qualifying services wherein care planning is established, implemented, revised or monitored and the billing practitioner work consists of ongoing oversight, direction, and management that assumes 15 minutes of work.
  2. Complex CCM (CPT 99487):  Requires 60 minutes or more of clinical staff time in qualifying services wherein care planning is established or substantially revised and the billing practitioner provides ongoing oversight, direction, and management, in addition to medical decision-making of moderate-high complexity that assumes 26 minutes of work.
  3. Complex CCM Add-on (CPT 99489 to be used with 99487):  To be used for each additional 30 minutes of clinical staff time that is required wherein care planning is established or substantially revised and the billing practitioner work consists of ongoing oversight, direction, and management in addition to medical decision-making of moderate-high complexity that assumes 13 minutes of work.
  4. CCM Initiating Visit:  Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), Transitional Care Management (TCM), or Other Qualifying Fact to Face Evaluation and Management (E/M). Billing practitioner work includes usual face to face work required by the billed initiating visit code.
  5. Add-On to CCM Initiating Visit (G0506):  Where care planning is established and the billing practitioner work includes personally performing extensive assessment and CCM care planning beyond the usual effort described by the separately billable CCM initiating visit

Unfortunately, CMS did not reduce the stringent requirements that providers must follow to successfully provide and get reimbursed for these CCM services. However, did make some updates for 2017 that reduce some of the initial obstacles that practitioners may face. Here are the updates:

Initiating Visit

  • Now only required for new patients or patients not seen within 1 year prior to commencement of CCM
  • Extra payment for extensive initiating services by the CCM practitioner (G0506)

Certified EHR and other electronic technology requirements

  • Certified EHR still required to standardize formatting in the medical record of core clinical information (demographics, problems, medications, medication allergies), but certified technology no longer required for other CCM documentation or transitional care management documents
  • No specific technology requirements for sharing care plan information electronically within and outside the practice, and fax can count, as long as care plan information is available timely (meaning promptly at an opportune, suitable, favorable, useful time)
  • Individuals providing CCM after hours no longer required to have access to the electronic care plan, as long as they have timely information
  • Remove standards for formatting and exchanging/transmitting continuity of care document(s)
  • Continue to encourage and support the use of certified technology and increased interoperability, but code-level conditions of Medicare Physician Fee Schedule (PFS) payment may not be the best means of accomplishing this. Practitioners are likely to transition to advanced electronic technologies due to incentives of the Quality Payment Program, independent of CCM rules.

Continuous Relationship with Designated Care Team Member

  • Improved alignment with CPT language for administrative simplicity.

Comprehensive Care management and Care Planning

  • Improved alignment with CPT language for administrative simplicity and appropriate caregiver inclusion
  • No longer specify format of the care plan copy that must be given to the patient (or caregiver if appropriate)
  • Electronic technology use standards relaxed (see above)

Transitional Care Management

  • Improved alignment with CPT language for administrative simplicity
  • Clinical summaries used in managing transitions renamed “continuity of care document(s)”
  • Electronic technology use standards relaxed (see above)

24/7 Access to Address Urgent Needs

  • Improved alignment with CPT language
  • Clarifying the required access is for urgent needs

Advance Consent

  • Verbal instead of written consent is allowed(but must still be documented in the medical record, and the same information must be explained to the patient for transparency).

Changes such as reducing the initiating visit requirements and allowing verbal consent instead of written will make it easier to get patients enrolled in CCM services. Thankfully, CMS also realized that CCM was not the appropriate arena for enforcing certified EHR technology. However, their language makes it clear that they are still encouraging providers to utilize CEHRT. Use this link to join us for our next CCM webinar titled:  Will Chronic Care Management Work for Your Practice?



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