Author Archives: Dinesh Raman

Chronic Care Management (CCM) Medicare Reimbursement Rates – Updated by Region

The Medicare reimbursement for CPT codes 99487, 99489, 99490, 99491, and G2058 can be claimed by care providers who offer chronic care management to their patients suffering from two or more chronic conditions. The care provided under CCM with advanced consent includes:

  • Continuity of Care with Designated Care Team Member
  • Comprehensive Care Management and Care Planning
  • Coordination with Home and Community-Based Clinical Service Providers
  • 24/7 Access to Address Urgent Needs
  • Enhanced Communication (ex. email, app notifications)

CPT 99487:

This code can be used by qualified medical professionals who offer non face-to-face chronic care management for at least 60 minutes per consultation. Medical practitioners can charge roughly $92 per session and this code can be claimed once a month for each patient. The 60 minutes scheduled should cover ongoing oversight, direction, and management of care plans.

CPT 99489:

This code allows medical care to bill up to $45 for every additional 30 minutes of non face-to-face consultation provided to the chronic patient. It must be used along with CPT 99487 to establish a care plan or substantially revise an existing plan. A care plan should include a complete assessment of patient needs taking into account the physical, functional, psychological and environmental conditions of the patient.

CPT 99490:

This code involves at least 20 minutes of non face-to-face consultation that can be used to monitor the vitals, check the compliance to care plan, and assess the effectiveness of the ongoing care treatment. The USA average reimbursement rate for CPT 99490 is $42 per consultation per patient. Each patient may be billed under CPT 99490 once per month.

CPT 99491:

This code can only be used by a physician or other qualified healthcare professional rather than any clinical staff. It charges about $84 per consultation and can be billed once a month. This code was introduced in January 2019 for consultations that exceed 30 minutes. The billing is roughly double that of CPT 99490 as it involves twice the allocated time (30 minutes vs 15 minutes). CPT 99491 and CPT99490 cannot be billed in the same calendar month.

G2058:

This code was introduced in January 2020 for every additional 20 minutes of nonface to face consultation. The care involves non-complex CCM and can be directed by either clinical staff or physicians/other qualified professionals. This code must be used in tandem with CPT99490 for any care that is 41-60 minutes in length. It is not necessary to use this code for sessions that are 21-40 minutes in length. As this code is being paired with CPT99490, it cannot be paired with any other CPT codes during the same calendar month. 

The following table lists the 2020 Chronic Care Management reimbursement rates for CPT 99490 across various states or regions in the US.

REGION CPT 99490 REIMBURSEMENT ESTIMATES 2020
USA Average $42.23
Alabama $39.27
Alaska $54.60
Arizona $41.01
Arkansas $38.18
California, Alameda/ Contra Costa County $49.03
California, Los Angeles County $46.07
California, Marin County $48.40
California, Napa County $46.88
California, Orange County  $46.07
California, San Francisco City $49.03
California, San Mateo County $49.03
California, Santa Clara County $50.04
California Ventura County $45.61
Rest of California $43.29
Colorado $42.69
Connecticut $45,14
DC + MD / VA Suburbs $47.97
Delaware $42.78
Florida Fort Lauderdale $43.62
Florida Miami $45.44
Rest of Florida $41.59
Georgia, Atlanta $42.18
Rest of Georgia $39.82
Hawaii/ Guam $44.43
Idaho $38.68
Illinois, Chicago $44.81
Illinois, East St Louis $42.23
Illinois, Suburban Chicago $44.47
Rest of Illinois $40.71
Indiana $39.06
Iowa $39.10
Kansas $39.27
Kentucky $39.19
Louisiana, New Orleans $41.68
Rest of Louisiana $39.99
Maine, Southern Maine $41.55
Rest of Maine $39.53
Maryland, Baltimore / Surr. Cntys $45.14
Rest of Maryland $43.24
Massachusetts, Metropolitan Boston $46.62
Rest of Massachusetts $43.83
Michigan, Detroit $43.16
Rest of Michigan $40.33
Minnesota $41.30
Mississippi $38.17
Missouri, Metropolitan Kansas City $41.21
Missouri, Metropolitan St Louis $41.43
Rest of Missouri $38.89
Montana $42.23
Nebraska $38.89
Nevada $42.53
New Hampshire $42.99
New Jersey, Northern New Jersey $46.71
Rest of New Jersey $45.27
New Mexico $40.67
New York, Manhattan $48.52
New York, NYC Suburbs / Long Island $49.79
New York, Poughkeepsie/ NYC Suburbs $45.22
New York, Queens $49.96
Rest of New York $40.63
North Carolina $40.20
North Dakota $40.96
Ohio $40.54
Oklahoma $39.40
Oregon, Portland $43.07
Rest of Oregon $40.63
Pennsylvania, Metropolitan Philadelphia $44.72
Rest of Pennsylvania $40.84
Puerto Rico $42.31
Rhode Island $43.67
South Carolina $39.49
South Dakota $40.54
Tennessee $39.06
Texas, Austin $42.35
Texas, Beaumont $40.29
Texas, Brazoria $42.40
Texas, Dallas $42.35
Texas, Fort Worth $41.64
Texas, Galveston $42.57
Texas, Houston $43.03
Rest of Texas $40.58
Utah $40.41
Vermont $41.43
Virginia $41.85
Virgin Islands $42.31
Washington, Seattle ( King County) $45.86
Rest of Washington $42.14
West Virginia $39.57
Wisconsin $39.82
Wyoming $41.64

The tabular data is for estimation only. It is not a legally bound guarantee of results. Please check for revised rates in your area. HealthViewX is not liable for the accuracy of this content. The data is for calculation estimation only.

Reference:

1) CMS.gov – County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.

2) Reimbursement amount from the CY 2015 Physician Fee Service Final Rule, October 31, 2014, averaged across 89 localities.

3)https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/CY2020-PFS-FR-Final-Report.pdf

FAQs – Chronic Care Management Medicare Reimbursement Billing

Care providers across the United States of America are monetizing Medicare chronic care management billing reimbursement codes to increase revenue from their practice. Read on to find answers to all the most commonly asked questions about patient eligibility, the scope of services, CPT codes and payment reimbursement for Medicare CCM.

Patient Eligibility

FAQ: Are all Medicare patients eligible for CCM reimbursement?

Answer: According to the Centers for Medicare & Medicaid Services (CMS), CCM is for “patients with two or more chronic conditions. A chronic condition is expected to last at least 12 months or the patient’s entire lifetime. The condition should be diagnosed to place the patient at significant risk of death, or functional decline.

FAQ: How can a care provider decide which condition meets CMS’ definition for CCM eligibility?

Answer: CMS has not specified or listed the eligible chronic conditions that meet this definition. CMS does have a databank regarding chronic conditions (http://www.ccwdata.org) that care providers can use. However, this list is very narrow. In general practice, CMS  requires a clear communication within the care plan that the chronic conditions being treated post a significant risk of death or functional decline.

FAQ: What about patients who are Medicare beneficiaries but also eligible for Medicaid?

Answer: CMS CPT codes can be used while billing for CCM treatment given to Medicare beneficiaries who are also eligible for Medicaid.

FAQ: How to kickstart the process of bringing a patient under CCM care?

Answer: An initial appointment must be fixed for a comprehensive evaluation of the patient. This is known as a “Welcome to Medicare” visit and includes an initial preventive physical examination. A patient must have received an introduction to Medicare CCM billing in person to be able to bill separately for CCM services. Until the changes made in 2017, a consent form signed by the patient was mandatory during the patient’s initiation into the CCM program. As per the CMS requirement, the consent form is no longer mandatory.

Scope of Services

FAQ: What are the scope of services for CCM reimbursement as defined by CMS?

Answer: CMS defines the scope of CCM services in the following way:

  1. Provide patients with access to care management services at any time of the day. This means patients should be able to contact the care provider during any emergency or urgent chronic care need 24-hours-a-day, 7-days-a-week. This may be through calls, SMS, email, internet applications or other means agreed upon by the patient and care provider.
  2. Established care continuity with a designated provider with whom the patient is able to schedule appointments, discuss care plan compliance, report vital stats and discuss any discomfort that arises.
  3. Creation of a patient-centered care plan document taking into consideration the physical, mental, functional and environmental factors of the patient. This includes an assessment of the support system and resources accessible to the patient.
  4. Care management for chronic conditions including assessment of patient’s medical, functional, and psychosocial needs. Regular follow-ups to ensure timely receipt of all recommended preventive care services, adherence to the suggested care plan and timely medication.
  5. Regular follow-up after a patient visits the emergency department, after discharges from the hospital or other healthcare facilities. Coordination with home/community based clinical service providers to support a patient’s care plan adherence.
  6. Use of certified electronic health record (EHR) and a patient consent form were mandatory until the changes in 2017 which made them optional.

Chronic Care Management CPT Billing Codes and Payment

FAQ: Which CMS Medicare billing codes can be used to bill CCM?

Answer: For the chronic codes that can be billed are below.

CPT Code Billing Amount(approx) per consultation Description
CPT99490 $42 Min 20min non-face to face time monitoring the care plan
CPT99480 $60 Min 60min non-face to face consultation time establishing or monitoring a care plan
CPT99489 $47 To be billed with CPT 99487 for every additional 30 min of non-face to face consultation


FAQ:  Are CCM services subject to Medicare’s co-paying system?

Answer: Yes. After the deductible is met, the 20 percent coinsurance charged to the patient will be about $8 to $9 for a month’s work of CCM with CPT 99490.

FAQ: Can you bill CCM for patients in an assisted living facility?

Answer: According to CMS, CPT code 99490 can be billed only for CCM services provided to a patient who is currently not the inpatient of a hospital. The patient must not be residing in a facility that receives payment from Medicare for that beneficiary.

FAQ: Is billing for CCM services limited to primary care physicians?

Answer: Physicians and Non-Physicians can claim reimbursement by billing for CCM CPT codes. CCM code is most likely to be billed by primary care physicians. However, specialists, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse midwives who meet the requirements may also bill for these services.

FAQ: Can the non-face-to-face time spent creating the care plan count toward the 20 minutes necessary to bill 99490?

Answer: Yes, it can.

Care Plan

FAQ: What does the care plan have to include as required by CMS?

Answer: The plan of care should include details of the following elements:

  • Problem list detailing the chronic conditions the patient suffers from
  • Expected outcome and the likely course of the disease
  • Measurable treatment goals
  • Symptom management
  • Planned interventions through regular follow-ups and vital data collection from patient
  • Medication management depending on any concerns/reactions/improvement reported by the patient
  • Care coordination plan between care provider and patient’s caregiver such as family/nurse/community housing etc
  • Requirements for periodic review and revision of the care plan as required.

FAQ: Do I have to provide the patient with a copy of the care plan?

Answer: Yes. CMS requires the care provider to share the care plan with the patient in a written or electronic format.

4 ways to choose an effective Referral Management System

The healthcare industry is looking to technology to streamline various administrative and operational processes. As a practice grows and new services are included, manually tracking all the required parameters is not practical, is time-consuming and is not economical. A deficiency in managing operational processes will result in loss of patients and revenue leakage.

Are you among 50% of referring physicians who don’t know if their patients actually visited the specialist? If you are facing this challenge, the use of technology is highly recommended to solve the referral tracking problem. 70% of the specialists rate the patient referral information they receive from other providers as fair or poor. If you are in this segment, patient referral retention is a problem you must be familiar with. With every medical practice challenged to make most of its time, regular status updates on each referral allow for effective care coordination and timely workflows.

Whatever the size of your practice, there are at least four factors you must consider while choosing an effective medical referral management system.

Electronic Health Record ( EHR / EMR) Integration and Report Access

Ensure that the referral management system you choose integrates well with the EMR system used by physicians and specialists. In the initial stage of the referral cycle, access to detailed patient history and medical records helps eliminate duplicate tests and assess previous evaluation more accurately. Quick access to the medical records also helps specialists diagnose the problem faster. With secure access to patient’s medical records, specialists and physicians can coordinate better on an integrated plan addressing all the patient’s existing and previous medical conditions.

Comprehensive Dashboard

While using software for optimal operations, revenue tracking and patient pipeline, data analysis is key to maintain efficiency. A comprehensive dashboard must be able to help the referral coordinator evaluate the number of referrals sent out, referrals received and the status of each referral. A view of the pipeline helps monitor patient leakage and retain patients within the network. It also helps schedule appointments at a mutual convenience to patient and practitioner. Regarding revenue, knowing the patient pipeline and calculating the retention rate will help the practitioner predict the revenue inflow each month and grow the practice with realistic goals. It will also help the practitioner monitor parameters such as average revenue per patient, an average number of referrals in/out per month, quarterly revenue growth, most treated conditions, patients who need referral redirects etc which are vital statistics for the practice. Specifically monitoring completion rates and lead times will help providers monitor if the referrals they send out are accurate, scheduled and treatment completed. This helps improve patient retention rates in the long run.

Integrated cross-device communication platform

Care coordination and referral management should be a closed loop. On an average, a physician refers to 200+ other physicians and specialists. Currently, there are several open loops such as not knowing whether the patient completed the appointment, not knowing what treatment was prescribed after the referral was sent out and not knowing the levels of patient compliance with the care plan.  Such loops can be closed with easy, effective communication channels between the PCP and specialists. A good referral management system should allow quick access to PCP and specialist to each other. This may be through chat, emails or status comments. In the mobile age, cross-device communication sync must be available so that quick discussions between physicians and specialists are made possible and overall care quality can be improved. 

Referral Relevance

While sending a referral, parameters like specialist availability, procedures, protocols and specific business needs must be considered. The list of specialists in a provider’s network may belong to different practices and have specific skills. Sorting your database to find the most accurate patient-specialist match based on the patient’s medical conditions improves chances of better, faster diagnosis and healing. Patients are very involved in the healthcare decisions and would appreciate more information on the parameters considered when a specialist is being referred. By building credibility with accurate referrals, the loop between patient-physician and specialist is closed faster. Awareness of the patient status after referral helps the physician track if the patient actually completed the appointment with the specialist and follow up whether the suggested care plan is being compiled to. Patient retention can be improved with higher referral relevance.

The above-mentioned features are crucial while considering implementing a referral management system for your practice. HealthViewX referral management solution offers all these features and more! To understand more, contact our team to schedule a demo

11 Questions To Validate Before Choosing Referral Management System

A medical Referral Management System is essential for a health system or clinic which sends and receives patient referrals to other care providers. Using a referral management system helps to track and grow referral sources. Before deciding on a referral management system for your practice, there are various factors you should consider.

Following are 11 questions to address before choosing your referral management system

1. Is the system easy to adopt?

By choosing a referral management system that your staff and you can adapt easily, you can avoid wasting time on installation and implementation. Cloud-based referral software is recommended as it does not need any installation and a single sign up can get you started.

2. Is the system easy to navigate?

However comprehensive a referral management system may be, it must be easy to navigate through.  For non-technical clinicians, nurses, administrative staff at a hospital the system must be easy to comprehend and use even from the first instance. A simple workflow of the system helps save time not wondering what is the next required action.

3. Is the system expensive?

Various budgets suit various practices depending on the conditions treated, size of the referral network, number of referrals received and sent each month, number of employees who need to use the system etc. It is recommended that you pick a system within your budget with the necessary features so it can add value by optimizing the referral process and not be a financial burden on your practice.

4. Is the system scalable?

As your practice grows by volume of patients, a number of locations, referral network or a number of conditions treated, a referral management system should allow you to scale up or down based on the requirement. If your staff is overlooking 100 referrals per month now, you should be able to upsize ( increase by 10%, 50 %, double, triple or more!) your referral pipeline based on the requirement or downsize based on seasonality.

5. Does the system allow user hierarchy and access control?

A referral system can store different types of data like patient medical records, patient schedules, billing, insurance details, list of specialists referred to, dashboard overview, referral pipeline, referral status etc. Not all this information needs to be accessed by every employee of the practice. The admin team would need to view the patient pipeline, clinicians would need access to patient medical records and referral status, finance team would need access to billing and insurance details, management would need admin access to the dashboards to monitor overall performance and reports. Having a system with user hierarchy allows for boundaries to be maintained between data modules to ensure patient privacy and data security.

6. Can the system process multi-channel referrals?

A clinical practice with a good referral network receives referrals from multiple channels like phone, email, fax, chat, SMS etc. A missed referral is a missed opportunity for potential revenue of hundreds of dollars.  An efficient referral management system must be able to collate all the referrals automatically with minimal manual intervention.  A referral pipeline that shows a comprehensive list including all referral sources will help the practice track and grow referrals. A dashboard view of referral network indicating the performance of each referral source allows for analytics on revenue split based on referral source, a number of referrals from each source etc.

7. Does the system allow you to view detailed patient profile?

While diagnosing a patient, all medical history of that patient must be visible for accurate diagnosis and treatment. A comprehensive view of the patient profile helps consider details of other related ailments diagnosed earlier, prevent repeat tests from being prescribed, prevent unnecessary costs to the patient, suggest a more accurate specific specialist for referral based on patient’s current condition and medical history. Each action by a specialist against a referral should be recorded in a chronological order for documentation and future reference. A complete patient profile allows for faster and more accurate diagnosis.

8. Does the system allow easy secure access to patient records?

An effective referral system must store patient demographic and medical information securely for immediate access on any internet-enabled device. HIPAA compliance and data security must be maintained. Relevant information can be targeted to the treating clinician.  

9. Can medical records be shared among relevant clinicians?

Lack of proper communication channels create problems in the referral process. This leads to specialists not having access to required records and test results on time. The physical transfer of files put the patient protected information at risk of being misplaced, lost or compromised. The system should have the flexibility to restrict sensitive information. A good referral management system must allow PCPs to share patient documents securely and quickly.

10. Can you track what happened to your referral after you sent it?

Referring providers mostly do not know what happened to a referral they sent. After the referral is sent the PCP is out of touch with the rest of the process and this can have serious repercussions like inappropriate re-referrals, inefficient care or lack of time-bound care, patient dissatisfaction, and even malpractice lawsuits.

11. Does the system ease communication?

A referral system must keep the PCP always in the loop by providing information on the status of referral sent and a secure channel to share notes and documents. A referral system must enable convenient communication between the primary care provider, specialist and other clinicians involved in the patient diagnosis. With effective communication, quick resolutions of queries are possible enabling optimal care orchestration.

If you are looking for an effective medical referral management system, consider a 30-minute walkthrough with the HealthViewX team. Our specialists will guide you through the HIPAA compliant industry-leading features with user-centric modern design.

Chronic Care Management CPT Codes 99490, G2058, 99491, 99487 & 99489 – All you need to know

The remote execution of Chronic care management is a win-win for both patients and care providers. The Medicare CPT codes for chronic care management encourage care providers to offer remote healthcare to chronic patients. Across America, care providers are growing their practice through the additional revenue channel of CCM Medicare CPT codes reimbursement. In all cases, documentation of consent should be maintained.

How do patients benefit from Chronic Care Management?

Patients with two or more chronic medical conditions can benefit from the CCM services. Chronic diseases are defined as those conditions expected to last a minimum of 12 months after diagnosis and put the patient at a risk of death or functional decline.  

Patients above the age of 65 can stay connected through telephone, web, or mobile applications with their care providers for regular monitoring and in case of emergencies. Such coordinated care improves their wellbeing and reduces the cost incurred in face-face treatment if it is substituted by remote care.

How can medical professionals benefit from Chronic Care Management CPT Codes 99490, 99491, 99487,G2058 and 99489?

Physicians and Non-Physicians can benefit from Medicare’s reimbursement for chronic care services.

Non Physicians include Certified Nurse-Midwife, Physician Assistant, Nurse Practitioner, and Clinical Nurse Specialists. The flexibility of remote medical monitoring offers patients and professionals convenience to reach out as per their schedule.

CPT Code CPT Amount(approx) per consultation Description
CPT99490 $42 Min 20min non-face to face time monitoring the care plan
CPT99491 $84 30 minutes or more; must be performed personally by a Physician or other qualified healthcare professional
G2058 $38 To be billed with CPT99490 for every additional 20 minutes of non face-to-face consultation
CPT99487 $92 Min 60min non-face to face consultation time establishing or monitoring a care plan
CPT99489 $45 To be billed with CPT 99487 for every additional 30 min of nonface to face consultation

CPT 99490:

By using this code, care providers can bill approximately $42 per consultation. This includes at least 20 minutes of non face-to-face consultation that can be used to monitor the vitals, check the compliance to care plan, and effectiveness of the ongoing care treatment. This time can also be used to establish a new care plan based on the patient’s condition. Care providers must keep in mind that only one medical professional can bill using this code per patient every month. To claim the reimbursement for care provided to the patient, the claim must be submitted once a month by the professional who provided care in that month. Medical practitioners should also use a recognized Electronic Medical Record (EMR) System to securely access the patient records remotely.

G2058:

This code was introduced in January 2020 for every additional 20 minutes of nonface to face consultation. The care involves non-complex CCM and can be directed by either clinical staff or physicians/other qualified professionals. This code must be used in tandem with CPT99490 for any care that is 41-60 minutes in length. It is not necessary to use this code for sessions that are 21-40 minutes in length. As this code is being paired with CPT99490, it cannot be paired with any other CPT codes during the same calendar month. 

CPT 99491:

This code was introduced in January 2019 and care providers may bill $84 per consultation. The code has a few significant differences from the similarly named CPT 99490. 99491 must involve a physician or other qualified healthcare professional rather than any clinical staff. Also this new code is specifically for consultations that exceed 30 minutes. These two codes cannot both be used in the same calendar month and a CPT 99491 can only be issued once in a month. The billing is roughly double that of CPT 99490 as it involves twice the allocated time (30 minutes vs 15 minutes).

CPT 99487:

Using this code, medical professionals may bill approximately $92 per consultation. This code may be used by medical professionals who offer chronic care management for at least 60 minutes per consultation. This refers to non face-to-face consultation. In cases where 20 minutes of care may not be sufficient and additional detailed monitoring is required, CPT 99487 code may be used. In this case, treatment includes advanced medical care planning and monitoring. A recognized electronic record system ensures smooth care transition between primary care providers and specialists. The 60 minutes scheduled should cover ongoing oversight, direction, and management of care plans. Decision making of moderate-high complexity may be needed. This code can be used by only one medical professional per patient per billing cycle. The claim for CPT reimbursement can be submitted once a month.

CPT 99489:

This code has to be used along with CPT 99487. With this code, medical care providers can bill up to $45 for every additional 30 minutes of consultation provided to the chronic patient. This additional time may be used to establish a care plan or substantially revise an existing plan. A care plan should include a complete assessment of patient needs taking into account the physical, functional, psychological and environmental conditions of the patient.

Challenges in implementing Chronic Care Management for Medicare reimbursement:

Care providers have to put in a lot of workloads doing back-end non face-to-face tasks to manage patients. This includes time to schedule appointments, follow-ups to ensure that the patient is complying with the care plan prescribed, or calls to collect vital patient information at regular intervals.

The Medicare CPT codes CPT 99487, CPT 99489, CPT 99490, CPT G2058 and CPT 99491help practitioners monetize these previously unbilled tasks. The chronic care management CPT codes allow for billing up to $42 for 20-minute non face-to-face care time with the patients. While this provides practitioners with an additional stream of revenue, it comes with its own implementation challenges.

      1. The technical preparedness of the practice: Medicare CCM codes can only be billed by hospitals which have a certified electronic medical record (EMR/EHR) system integrated into their practice. Such a large financial commitment is not always affordable, especially for smaller practices. In 2017, changes were proposed to remove the clause which mandates the requirement of EHR systems for Medicare billing.
      2. Patient Consent: Before billing for Medicare CPT codes, providers must obtain patient consent. Since there are no readily available templates of the consent form, each practice must spend time in creating templates that can be used based on the patient profiles they treat. The consent forms must also be stored for future reference. Obtaining patient consent before each appointment can be time-consuming. In 2017, it has been recommended to phase out the mandatory consent procedure.
      3. Staffing needs and Billing time: Since the CCM services can be billed only at the end of each month, records such as the discussion details, conversation/email summary, and care plans must be maintained for each patient serviced through CCM. Additional staff may be needed to manage the patient consent, bill submission, and accounting procedures. This adds to the overheads of the practice.
      4. Patient payments: Medicare does not bear 100% of the charges for consultation through CCM. Patients have to pay 20% (about $8 per consultation) of the charges. This makes patients reluctant to sign the consent form for CCM. Quick non face-to-face follow-ups on care compliance were being provided by practitioners as a part of extended patient service and optimal care quality even before the CCM CPT codes came into effect. Some patients expect this to continue and perceive billing for CCM as the provider’s greed for money.

To overcome these challenges, it is important to educate patients on the advantages of CCM and help them see the long-term value of providing consent for CCM services. The proposed changes to the mandatory consent and mandatory EHR requirement will also help more practitioners adopt CCM CPT codes.

Reference: https://www.hccinstitute.org/app/uploads/2020/02/What-You-Should…-2020-Coding-Updates_HCCI.pdf

Rising popularity of CCM – Common Chronic Diseases In The USA

Chronic illness rates are increasing year by year and are taking a toll on the nation’s population. Serious chronic diseases like stroke, diabetes, cancer, heart disease, etc. are one of the leading cause of increased death rate in the country. More than 75% of healthcare spending is on people with chronic conditions. Beyond any statistics, medication non-adherence is a poor clinical outcome and overcoming this is another great challenge. Thus, doing more to take care of the population health is crucial.

Even today, we witness patients suffering from poor access to healthcare and it is continuing to increase. So improving quality of life for people with chronic disease is vital and is an epidemic in the USA. Simultaneously, the burden of multiple chronic illnesses is also increasing rapidly. In one of the recent release, it is noted that two-thirds of Medicare patients have two or more chronic conditions; another one-third have four or more.  The growing impact of this condition is placing a huge economic demand on the nation. Utmost care has to be taken to address this growing condition, and addressing it will not only reduce cost but also increase the quality of life.  Taking steps towards better health and using care more effectively is a need today.

Chronic Care Management is a boon to both the providers and the patients. The Center for Medicare and Medicaid Services (CMS) has taken a lot of new initiatives to raise awareness of the benefits of Chronic Care Management. This initiative offers family physicians and other healthcare specialists the support they need to implement Chronic Care Management in their practice. It is all about providing care to patients with chronic illness through a framework for embracing healthy life, improving patient health and increasing revenue.

The prime goal of CCM is to improve care quality through remote monitoring and managing patient health conditions better by creating care individual care plans for each of the patients for achieving better health outcomes.

Chronic Care Management promises the below

  • Continuity of care by the provider.
  • Individual care plan for patients.
  • 24/7 access to healthcare.
  • Assessment of patient health records, patient-generated health data.
  • Access patient health information at regular intervals.
  • A secure electronic platform to share patient information and care plans
  • Managing care transitions

Apart from this Chronic Care Management includes non-face-to-face care management and care coordination. The transition from fee-for-service to value-based payment has a huge impact in the healthcare industry. And the CCM billing model makes it possible by getting paid for the time and effort the care team invests in their patients. It is evident that this is benefitting both the patient and the provider. CCM has gained in traction through the value the physicians bring in by delivering continuous and connected healthcare. For the past many years, physicians have helped patients over the phone but never got paid for it. But now with the introduction of Chronic Care Management (CCM) by Center for Medicare and Medicaid Services (CMS) this has been resolved. Patients can elect one physician to take care of their CCM program. The elected CCM physician or provider must establish, implement, revise, or monitor and manage an electronic care plan that addresses the physical, mental, psychosocial, functional, and environmental needs of the patient as well as maintain an inventory of resources and supports that the patient needs. Thus, the practice must use a certified EHR to bill CCM codes. The CPT CPT codes 99490 and 99487, and the add-on CPT code 99489 is a new source of revenue for the physicians’ and other care providers.

And it is no surprise that CCM is gaining popularity among all the care providers, physicians, and patients. Schedule a demo with us to know more about HealthViewX – Chronic Care Management Solution