CHRONIC CARE MANAGEMENT (CCM)€¦ · CCM Service • Must use a Certified EHR Technology • 24/7...

CHRONIC CAREMANAGEMENT

(CCM)

Dan GodlaFounder and CEO

ThoroughCaredan@thoroughcare.net

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What is Chronic Care Management (CCM)?

THERE ARE 21.4 MILLION MEDICARE PATIENTS WITH 2 OR MORE CHRONIC CONDITIONS

ANNUAL MEDICARE SPENDING IS OVER $300BPATIENTS WITH 2 OR MORE CHRONIC CONDITIONS ACCOUNT FOR $285 BILLION OF THIS SPENDING

In 2015, Medicare developed a new program to reduce Chronic Conditions

Medicare will now reimburses doctors for “non-face-to-face” engagements for their Medicare patients with 2 or more Chronic Conditions. This program is called the Chronic Care Management (CCM)

This program will reimburse doctors ~ $42 per patient per month. An average-sized doctors office with 250 qualified patients can generate around $10,000 per month in additional revenue to manage these patients.

HOW IS THE PROGRAM STRUCTURED?PROVISION OF COORDINATED CARE SERVICES TO PATIENTS WITH MULTIPLE CHRONIC CONDITIONS

• Calendar-Month Program(1st of the month to the last day of the month)

• Patients must agree to participate

• Includes non-face-to-face interactions related to the patient’s health

• Tracks patient’s health issues through a Comprehensive Care Plan

WHAT IS REQUIRED FOR CCM?DETAILED LIST OF REQUIREMENTS FROM CMS

PATIENT PROVIDER

• 2 or More Chronic Conditions

• Serious Health Risk or at risk of death

• Must Consent to the CCM Service

• Must use a Certified EHR Technology

• 24/7 Access to Care Management Services

• Comprehensive Patient-Centered Care Plan

• Documented time spent per patient

• Care Plan available 24/7 to entire staff

• Care Plan shared with EMR and other providers

• Monthly Reports and Summary of CCM

• May have a Co-pay

• 20 minutes per patient per month

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A History of CCM

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2015

• Chronic Care Management Program Launched

• Reimbursement: CPT 99490 pays around $42 per CCM

• Written Consent Required

• RHCs and FQHCs were prohibited

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2016

• RHCs and FQHCs are now allowed to participate

• The restrictions were significantly tighter• 3rd-party groups COULD NOT assist with CCM. • Practices were also required to provide 24/7 access to care

directly from the provider or direct staff. The logistics of this made CCM extremely difficult for these groups.

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2017• RHCs and FQHCs restrictions removed

• Now operate under “General Supervision”• 24/7 Care not mandatory “in-house”• Office visit (E/M) not required to initiate CCM• Verbal Consent Allowed

• FFS offered new Reimbursement tiers for over 60 minutes and each 30+ minuets afterwards

• 99490 for 20-minute CCMs (pays around $42)• 99487 for 60-minute CCMs (pays around $90)• 99489 for 30+ minutes of CCM (pays around $45)

• New Tiers not available to RHCs and FQHCs

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The NARHC argued to CMS that it was unfair to limit RHCs (and FQHCs) to simply the 20-minute CCM code while their FFS peers could bill for 60-minute and add-on CCM codes.

CMS agreed and the conversation turned to how to create that payment equity. We initially proposed that CMS allow RHCs to bill the various levels and receive payment accordingly. However, CMS wanted there to only be one RHC CCM payment for sake of simplicity.

– Nathan Baugh / NARHC

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2018

• New Code created for RHCs and FQHCs:• G0511 – pays $62 for any CCM over 20-minutes

• Per CMS: “We sought to develop a methodology for payment of care management services that is consistent with the RHC and FQHC payment principles of bundling services and not paying for services based on time increments.”

• FFS groups still receive their tier structure:• 99490 for 20-minute CCMs (pays around $42)• 99487 for 60-minute CCMs (pays around $90)• 99489 for 30+ minutes of CCM (pays around $45)

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A Comprehensive“Patient-Centered” Care Plan

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COMPREHENSIVE PATIENT- CENTERED CARE PLAN ACCORDING TO CMS

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CREATING A TRUE PATIENT- CENTERED CARE PLANBASED OUR SOLUTION ON THE AMERICAN ACADEMY OF FAMILY PHYSICIANS

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Let’s do a Care Plan together

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Monthly CCM Review

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Non-Face-To-Face Activities

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Non- Face- To- Face Tasks

• Monthly Clinical Review• Telephone Call With Patient• Physician Review of labs/test• Physician Review of Care Plan• Initial Action Items• Discussions with Other Providers• Scheduling Appointments/Services• New Patient Preparation• Referrals• Prescription Refills• Portal Messaging• ePrescribe• Home Health / Hospice Orders• Care Plan Reconciliation

• Telephone Call with Provider• Telephone Call with Facility• Updating Patient Health Record• Lab/Radiology Orders• Patient/Facility Forms• Physician Review of Consult Notes• Physical Review of hospital/Facility Records• Initial Patient-Centered Care Plan• Letter to Patient• Letter to Provider• Preauthorization• Discussion With Patient’s Family or Caregiver• Monthly Chart Review

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Tips for CCM Success

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Tips for Successful Programs

• The best programs have engaged providers

• Train your entire staff

• Prioritize your candidates

• How to address the Patient Copay

• Tips for Billing

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Billing a CCM Claim

• When Billing Medicare-B as an RHC:• Use CPT Code G0511• Include 2 ICD-10 Codes (to identify the 2 Chronic Conditions)• Date of Service = Date the patient went over 20-minutes• Billing Provider = Doctor / NP providing “General Supervision”

• When Billing other insurances• Use CPT Code 99490• Always check with Commercial Insurance or Medicare Advantage Plans

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Conclusion

• Every RHC in South Carolina Should do CCM

• Many of these activities – you already do today!

• Revenue is significant: 250 patients generates $15,000 per month

• Improved Patient Quality and Satisfaction

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Q&A

Dan Godladan@thoroughcare.net

Thank you!Any questions?