On January 1st, 2015, the Centers for Medicare and Medicaid Services (CMS) started reimbursing providers who actively manage care delivery for Medicare patients suffering from two or more chronic conditions. Providers are required to provide at least 20 minutes of follow-up care outside of the office (non-face- to-face care).

Medicare has stated that they plan to monitor and update CCM requirements on an ongoing basis. There is no indication that the program will be discontinued. CCM was specifically addressed in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which outlined numerous addressed certain requirements in the CCM program, he CCM program is being continued for will continue indefinitely. reimbursement are not Medicare Physician Fee Schedule.

Medicare estimates that 2 out of every 3 Medicare beneficiaries, roughly 35 million patients, would qualify for CCM services.

The average compensation, depending on geographic area, for providing CCM services is approximately $42 per month/per patient.

Practitioners may bill for CCM services for a patient each month, using CPT code 99490, whenever the following criteria are met:

Standard documentation principles apply.

Medicare Part B patients with no secondary coverage will be responsible for about $8/month. However, many Medicare patients have co-insurance that will cover the copayment fee.

Surveys have in general identified three areas that have contributed to slow adoption of CCM services, despite the program's value to patients and practices.

Explaining the value of the program to patients should help. Medicare has created this program in an effort to expand the level of care provided by medical practices. These additional efforts will help patients remain out of the emergency room and the hospital. It will help them avoid unnecessary tests and referrals, and reduces medical errors through better communication between healthcare providers. It will also help understaffed medical practices hire additional employees that can help patients in many different ways.

Not if the time spent with the patient is a component of a billable home health service, or if the provider is overseeing (and billing for) home health services.

At least 20 minutes of non-face-to-face care to Medicare beneficiaries enrolled in CCM during a given month is required. This service must be delivered during that billing month and cannot be applied to future months.

Non-face-to-face care management services may be furnished inside or outside of the provider's office, however they must be services that are normally provided in a non-face- to-face setting. Clinical staff must perform these services under the general supervision of a physician (not necessarily the billing physician).

This time could be applied toward the required 20 minutes, if performed by licensed clinical staff.

In many states certified MAs can provide CCM services. The term Clinical Staff Members is defined by the AMA in the Current Procedural Terminology code book. It is defined as a person who, under the supervision of a practitioner, is allowed by law, regulation, or facility policy to perform or assist in the performance of a specified action. Clinical competency should be determined by the physician in conjunction with state regulations, patient needs, etc.

CMS has stated they have left the determination of what should be considered a chronic condition open to the provider. The guideline simply requires:

A provider cannot bill for CCM unless and until the provider secures the beneficiary's written consent.

This has not been directly addressed, however, at this time we are not recommending that CCM services be billed unless the time spent with the patient is during a one-on- one session.

CMS's intent was to have primary care be the primary beneficiary of the CCM program, however any eligible Medicare provider may perform and bill for CCM services.

Yes, specialists such as cardiologist and oncologists can provide chronic care management services.

CMS requires the billing practitioner to initiate the CCM service as part of an Annual Wellness Visit, Initial Preventive Physical Examination, or comprehensive evaluation and management visit to the patient prior to billing.  CCM can be billed for this first month if the consent form is signed.

Only one provider may bill on any given month. The patient must notify the provider in writing, and the service will cease on the last day of that month.

There is no standard form. However, typical components of care plan are:

The provider should have the capability to transmit the summary care record and the care plan electronically but not through facsimile.

Patient portals are understood to be one way of helping to address or support certain CCM requirements that relate to the care plan and provider access. There is no specific requirement that ties the provision of a patient portal to Medicare's CCM program, however, there are requirements associated with Meaningful Use that directly relate to patient portals.

Generally, it means patients must be able to reach a member of the care team 24 x 7 for direction and support. For example, rather than leaving a message on an answering machine that directs CCM patients to the closest emergency room, practices should have a system that enables patients to discuss symptoms with a physician, or another care team member, in order to determine the most appropriate health intervention.

Yes. Below services cannot overlap with CCM services on the same day, if billed by the same practice:

Yes, this would be considered a non-face- to-face service and offers additional benefits to patients.

Medicare and Medicare Advantage plans. A few selected private carriers are offering CCM plans, however this remains primarily a service for Medicare beneficiaries.

The average reimbursement is about $42, but this varies by geographic region.