Monthly Archives: February 2017

Complex CCM Codes To Expand Care Opportunities

On November 15, 2016 – the Centers for Medicare and Medicaid (CMS) announced the new changes to Chronic Care Management payment options by adding new codes and key improvements to the existing CCM billing methods and services.

Feedback from providers is the key reason for new codes. These changes are now set to implement on practices starting 2017 with an objective to enhance patient care and ensure hassle-free documentation for billing. Services offered by physicians will be based on the complexity of the patient’s need and will be billed under different CPT codes based on the service provided. Here is a summary of CCM and complex CCM codes.

CCM payment option till 2016

A physician will be paid $42 for 20 minutes of clinical staff time provided to patients with multiple (two or more) chronic conditions per calendar month under CPT 99490. Reimbursement for the provider will be the same if the clinical service time exceeds 20 minutes.

Changes in CCM codes effective from 2017

CMS recognized some patients may have complex chronic conditions and they might need additional care time. So, CMS addressed the need by introducing new codes 99487 and 99489 which will benefit those who need extra care and will also compensate providers with increased reimbursement options through new codes.

  • CCM Code 99490
    Payment has increased from $42 to $43 for 20 minutes of clinical staff time.
  • Complex CCM Code 99487
    60 minutes of CCM service for $94 that includes moderate to high complex medical decision-making.
  • Add-On Complex CCM Code 99489
    This code is to use with 99487. Additional 30 minutes of service will be provided for bill amount $47.

In addition to the CCM codes, there are changes made in the service elements for enhanced care and administrative simplifications on billing.

CCM Service Changes for 2017

Initiating Visit

From 2017, initial visit is required for new patients or patients who have not enrolled their name for CCM services within past twelve months. Payment of $44-$209 to be billed by the billing practitioner for initiating visits.

For initial visit, CMS has introduced a new add-on code G0506 that includes extensive assessment and care planning performed by the billing practitioner beyond the usual efforts. A payment of $64 will be billed for this extensive initiation work- only once per patient per provider.

EHR and Technology requirements

CMS continues to stress on using certified EHR with a standard format (demographics, problems, medications, medication allergies, etc.) to record core clinical information.
It also states that the use of certified technology is no longer required for CCM documentation or care plan for sharing within or outside the network. Frequent access to care document is not required, given that providers have timely information on hand or for individuals providing CCM service after hours.
At the same time, CMS recommends physician to use certified technology as per the conditions of Medicare Physician Fee Schedule (PFS) payment to get points for the Quality Payment Program (QPP)
Beginning 2017, care plans can also be shared through fax as it has created more fuss last year among some providers when shared electronically.

Care Management

From now, the clinical summary is renamed as “continuity of care document(s)” and a care management plan copy given to patient requires no format. Usage of certified technology has been completely removed in this revision.
Beneficiary and caregivers are given the opportunity to communicate with the practitioner, not only through telephone, but also by means of secure messaging, Internet, or through any non-face-to-face communication methods.

24 hours access to care

Patients and caregivers are provided access to any of the physicians or other qualified professionals or clinical staff to make quick contact to address urgent care needs, not just for chronic care needs.
Continuous relationship with a designated member of the care team is improved to schedule quick and routine appointments.

Consent Change

Consent can be either verbal or written, but it must be documented in the patient record and the same should be explained for transparency.

How is Chronic Care Management Evolving?

The Centers for Medicare and Medicaid-recognized the importance of including a sustainable practice to manage care for patients suffering from multiple chronic conditions in the year 2015.
Medicare leveraged Physician Fee Schedule (PFS) options for CCM services offered to patients ailing from chronic conditions.

It’s been over 2 years since the implementation of Chronic Care Management services for patients.
CMS has closely observed the outcomes of those initiatives and has come up with plans that will increase the focus and funding towards the existing Chronic Care Management programs.

Let’s Understand CPT 99490

To be able to differentiate the purpose of the old codes from the new codes, one must understand the conditions for billing under CPT 99490. Chronic Care Management Services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:

  1. Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  2. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  3. Comprehensive care plan established, implemented, revised, or monitored

Assumes 15 minutes of work by the billing practitioner per month

What’s new in Complex CCM codes?

The primary limitation of CPT 99490 is the consulting time of 20 minutes, most practices felt the need to increase the consultation time for a patient.
Though CCM services resulted in positive outcomes, the results were far short of objectives.
Thus, they decided to increase the consulting time of CCM with new Complex CCM codes that can be used to provide 60 minutes of consulting in a calendar month and the duration of 60 minutes is billable.

Complex Chronic Care Management services, with the following, required elements:

    1. Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
    2. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
    3. Establishment or substantial revision of a comprehensive care plan
    4. Moderate or high complexity medical decision making
    5. 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

How does the billing work?

A patient must be billed either for Complex Chronic Care Management codes or the already existing Chronic Care Management code.
The same patient should not be included or billed under both the codes, that way there’s more organized workflow for billing and reimbursement.

Reporting Expectations

Chronic Care Management codes CPT 99487, 99489, and 99490 are reported only once in every calendar month by the practitioner who carried out the care management, no more than one claim per month was allowed.
In the case of Complex Care Management, each month a practitioner is expected to review patient’s health condition and classify whether the patient would still be under the procedures of Complex Care Management or the existing Chronic Care Management codes.

This is a crucial practice to establish the health outcome of the patients given the importance and assistance for chronic conditions, in addition to that practitioners are expected to meet the quality metrics that are recommended by CMS.

Implementation of Comprehensive Care Plan at a practice level

New Chronic Care Management codes stress the necessity and induce the interest in creating an individual care plan for each of the patient’s for achieving better health outcomes.
It is important for the healthcare provider to record and assess patient health information at regular intervals.

An electronic form of secure patient information needs to be generated, based on which a physician can come up with a care plan that is required for the patients.
With technology companies extending their influence in healthcare, remote patient monitoring and real-time patient data can be gathered and put to best use. Creation and execution of care plan is one of the primary responsibility of the provider to adhere to quality metrics expected by the CMS.

HealthViewX is in the business of Healthcare IT, we offer a suite of comprehensive IT solutions from Referral Management, Chronic Care Management and a holistic Care Management Platform.

5 Healthcare Trends To Watch Out

The past year was a year of change for the healthcare industry. From the news by late 2016 about how a staggering 95% of US hospitals have participated in Medicare EHR Incentive Program to the ever-increasing cyber-attacks on hospitals systems to CMS rolling out new regulations and rules to further the industry’s transition from fee-for-service-based to a value-based payment model.*

What changes will happen in the industry this year around? The first month of a year is the best time to ponder that question.

Here are 5 trends that we think will create ripples in 2017.

1. Blockchain Will Be Put to Work

Blockchain made a lot of noise last year. So what is blockchain? And, how does it work?

A blockchain is a distributed database that can store any values without repetition even after multiple updates. It stores information in blocks (in databases called records) and each block will have timestamp and link to a previous block.

For example, every time a transaction is made, the transaction data/information will be stored in a new block rather than updating an existing information, and the new block is added to the existing blocks forming a blockchain.

Basically, once data is created, it cannot be altered. The system will encrypt all the data stored and it is impossible for hackers to break into the system.

2. Healthcare Consumerism is on the Rise

Patients fund their health care expenses. Patients’ nowadays act as real consumers and seek for high-quality service for the cost incurred. Earlier patients were pressurized with large deductibles and it turned the table towards hospital providers to provide better care.

The rise in consumerism also increases the digital transformation in healthcare. Patients are now demanding the type of service quality that they are familiar with from other industries. Though digital push rises the care cost, it improves the patient’s engagement levels. The investment made in technology will enhance the digital consumer experience by making it more viable.

3. Telehealth to Serve More

Value-based and patient-centered care has providers’ attention on telehealth technologies. Telehealth service has drastically reduced the readmission rate and the cost of Chronic Care Management.

In addition to that, it has also improved communication after patients are discharged. “The number of Americans receiving virtual medical care is forecast to double, from 15 million in 2016 to 30 million in 2017”, according to American Telemedicine Association.

4. Cloud to Get More Attention

Data storage is still an unsolved puzzle for many providers. Though some opted cloud to improve practice management there were a lot of security concerns. Despite all, most accelerated technology investment of healthcare is expected to be made on Cloud in 2017.

“It wasn’t too long ago that people were skeptical of cloud computing, but today, over 83 percent of healthcare organizations are using cloud technology, according to a HIMSS Analytics Cloud Survey,” says Morris Panner, CEO of Ambra Health.

It is also estimated that the health cloud computing market will grow to 9.48 Billion dollars by 2020, a new report from MarketsandMarkets.

5. Cognitive Computer with Ease Process

The process of healthcare transformation is increasing the number of tasks performed. In the coming years, much time will be spent on understanding and finding ways to leverage the advanced computing system to better the clinical operations. Cognitive computers ease the process of analyzing the unstructured pattern of data.

For example, IBM cognitive machine surfaces insights by analyzing masses of data- personal, medical, practical, pharmaceutical, etc. Adapting such innovative technology in healthcare helps hospitals function more effectively.

Healthcare always strives to deliver good quality of service at lower costs by including technology elements such as telemedicine, cloud, analytics, cyber security, remote patient monitoring and also by trying out newer technology solutions to bring out the better outcome.

* “Hospitals Participating in the CMS EHR Incentive Programs”-

* “Ransomware: See the 14 hospitals attacked so far in 2016”-