New Tools Connect Patients to Chronic Care Management
We all want to provide the best care to our patients. The term “chronic care management services” or CCM has been buzzing through medical practices and among coders in the past few years. It has become a critical component of the care we provide to our patients with multiple chronic conditions, whose management is often complex and confusing for them. Chronic care management is a critical component of primary care that contributes to better health and care for individuals with multiple conditions. Centers for Medicare & Medicaid (CMS) data
shows that two thirds of people on Medicare have two or more chronic conditions, which means many of your patients may benefit from a CCM program, including the help provided between visits.
The Federal Office of Rural Health Policy at the Health Resources and Service Administration is partnering with the Centers for Medicare & Medicaid Services on the Connected Care
initiative to raise awareness about CCM and the billing code, CPT code 99490, which CMS established to increase payment for the additional time and resources your clinic spends to manage the care of patients with two or more serious chronic conditions outside of the usual face-to-face encounters. The code helps pay for the between-appointment help your Medicare and dual eligible (Medicare and Medicaid) patients with multiple chronic conditions need to stay on track with their treatment plans and overall health. The Connected Care
public education campaign is designed to help you provide CCM services.
Download the Connected Care Health Care Professional Toolkit
to find information about eligibility, resources about service requirements and how to bill, a video
featuring a health care professional talking about her experience, patient education video
, and other resources to help you build an effective program in your practice. You can also order printed resources for your waiting room or download by visiting go.cms.gov/CCM
. Materials are available in English and Spanish.
Why make the effort?
- Your practices’ patients will gain a dedicated health care professional who can help them plan for better health and stay on track. Services such as a comprehensive care plan, timely availability of patient health information, management of care transitions, and ready patient access to their care team can improve care coordination and patient self-management.
- Chronic care management services will help your practice deliver the coordinated care your patients need and deserve. CCM services are patient-centered, high-value services with the potential to improve outcomes for patients. For dual eligible beneficiaries in one Department of Health and Human Services led pilot program, integrated care resulted in beneficiaries being 48 percent less likely to have a hospital stay, 26 percent fewer hospital stays, and 38 percent fewer emergency room visits.
- Encouraging patients to use chronic care management services will give them the support they need between visits. Having a regular touch point may help patients think about their health more and become more conscious of taking their medications and other tasks. Getting this help may also help patients feel more satisfied with their care and, by staying on track, improve adherence to their treatments.
Patients are responsible for the usual Medicare Part B cost-sharing (deductible and copay/coinsurance) if they do not have supplemental (“wrap-around”) insurance. Please note that the majority of dual eligible beneficiaries (patients with Medicare-Medicaid) are exempt from cost sharing. Medigap plans must provide wrap-around coverage of cost sharing for CCM, and most beneficiaries have Medigap or other supplemental insurance.
Rural Health Clinics and Federally Qualified Health Centers may currently use CPT code 99490 for 20 minutes or more of care coordination. Please note that new billing codes for provision of chronic care management and behavior health integration are being finalized for 2018. To learn more about chronic care management under RHCs and FQHCs, see our FAQs
and Fact Sheet
Some updates have been made in 2017, reflected in Changes to Chronic Care Management Services for 2017 Fact Sheet, related to the allowance of oral informed consent, changes to reduce the administrative burden associated with providing CCM services, and the 2017 payment rate paid under the Physician Fee Schedule (PFS) for CPT code 99490.
Getting up to speed may take some effort, but offering chronic care management services provides you the opportunity to improve patient care and grow your practice.
Share this article with your colleagues so they can learn more about the Connected Care Health Care Professional Toolkit
, and other CCM resources. For more information about Connected Care, visit go.cms.gov/CCM
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