A chronic health condition is a severe mental or physical illness with symptoms lasting one year or longer, which requires ongoing care and often negatively impacts a person’s quality of life. Chronic Care Management (CCM) is a necessary tool for patients with chronic conditions since it’s a specific care management service that provides coverage for patients with two or more chronic conditions for a continuous relationship with their care team.
Under Chronic Care Management, the patient’s care team can bill for time spent managing the patients’ conditions. This includes formulating a comprehensive care plan, interactive remote communication and management (usually over the phone), medication management, and care coordination between providers. In fact, Chronic Care Management (CCM) has been recognized by the Centers for Medicare & Medicaid Services (CMS) as a critical component of primary care that contributes to better health and care for individuals.
How Does Chronic Care Management Work?
A CCM program helps improve patient experiences and outcomes while boosting clinical value and revenue. Also, a CCM program should be staffed by qualified, licensed clinicians who conduct the monthly patient encounters, whether in-house or outsourced. Although the path to success varies by clinic, below are four common steps to take toward establishing a CCM program:
- Identify patients who qualify and make the connection.
- Enroll interested patients.
- Provide monthly phone calls for each enrollee from a dedicated representative who understands their current medical challenges.
- Integrate patient assessments from each call directly into your EMR system, offering providers a more constructive conversation with their patients during office visits.
Why Should Patients Enroll In A CCM Program?
Generally, patients who enroll in CCM services most commonly have two or more chronic diagnoses which will last for twelve months or longer. Enrolled patients are typically individuals who would benefit from additional monitoring or oversight of their health, including vitals and general well-being. That said, below are some of the few reasons why patients should consider enrolling in CCM services:
- Chronic diseases are the leading cause of death and disability in the United States.
- Enrolling in Chronic Care Management services can help prevent or reduce hospitalizations and adverse health events.
What Are The Benefits Of Chronic Care Management Programs?
- Chronic Care Management is another avenue of revenue for primary care providers. In the first year after the implementation of CCM, CMS reimbursed providers roughly $52 million for their services. For the general CCM patient who requires care planning and general monitoring and oversight, physicians can earn at least $43 per patient per month. For more complex CCM patients who require at least 60 minutes of clinical staff time per month, practices could earn $94 per patient per month.
- Improved care for patients. CCM enhances care coordination and the use of proactive medicine. When patients can talk to their providers about prescribed medications and are given tools to manage their chronic conditions, we can reduce medical expenses and decrease emergency department and hospital utilization.
- Chronic Care Management improves support between office visits. A recent national survey of Medicare patients enrolled in CCM reported better communication from their providers. They felt they had more opportunities to discuss health concerns outside of the office. Patients also stated that they found the monthly check-ins from their care managers to be helpful reminders to pay attention to their health.
- Improved access to care. Chronic Care Management offers patients 24/7 access to care and ensures continuity of care. Additionally, they receive personalized care plans that consider their medical, functional, and psychosocial needs.
What Is A CCM-Eligible Chronic Condition?
Any condition that meets the criteria can qualify a patient for CCM. Some of the most common examples include:
- Alzheimer’s disease
- Cardiovascular disease
- Heart disease
- High blood pressure
- Multiple sclerosis
Other requirements must be met to code, bill, and get paid for CCM.
Who Can Provide Chronic Care Management?
Since Chronic Care Management is a billable service, only qualified providers can include CCM services in their monthly billing. Moreover, all activities from CCM are supervised by the following bill for these services, which include:
- Physician Assistants
- Nurse Practitioners
- Certified Nurse Midwives
- Clinical Nurse Specialists
That said, only one practitioner/facility per patient may be paid for CCM services for a given calendar month. However, services may be furnished by the billing healthcare professional and clinical staff that meet Medicare’s “incident to” rules.
To initiate Chronic Care Management services, the provider must complete an initial face-to-face visit, obtain the verbal or written consent of the patient, and develop a comprehensive care plan in the electronic health record (EHR). Nonetheless, it is important to note that CCM services are subject to the usual Medicare Part B cost-sharing requirement.
How To Deliver Effective Chronic Care Management?
To measure the efficacy of programs, the Wagner chronic care model has been widely used, which identifies 6 areas for effective interventions that include:
- Improved support for patients’ self-management
- Well-designed delivery of care
- Increased access to expertise and decision support
- Wider availability of clinical information
- Organized practice systems and provider roles
- Community support
These 6 areas can be applied to various chronic health conditions, clinical settings, and patient populations.
What Are the Chronic Care Management Codes?
As indicated, Chronic Care Management requires an initiating visit with the billing provider. For that reason, this visit includes most standard face-to-face Evaluation and Management (E/M) visit codes, Annual Wellness Visit (AWV), or Initial Preventive Physical Exam (IPPE).
Correspondingly, the initiating visit is only required for new patients or patients not seen by the provider in the previous year. Once the patient has consented to CCM and the initiating visit is complete, the following codes can be billed for each month of service:
- CPT code 99490. A non-complex CCM that is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability.
- CPT code 99439. This is for each additional 20-minute clinical staff time spent providing non-complex CCM directed by a physician or other qualified health care professional (billed in conjunction with CPT code99490)
- CPT code – 99487. A complex CCM that is a 60-minute timed service provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate- to high-complexity medical decision-making.
- CPT code 99489. This is for each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified health care professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490)
- CPT code 99491. The CCM services that are provided personally by a physician or other qualified health care professional for at least 30 minutes.
These are the five CPT codes used to report CCM services. Additionally, HCPCS Code G0506 is an add-on code to the CCM initiating visit that describes the work of the billing practitioner in a comprehensive assessment and care planning for patients outside of the usual effort described by the initiating visit code.
The Bottom Line
Chronic care management reduces the need for healthcare services and improves health outcomes, particularly for patients with chronic conditions. Sevid Beauty LLC offers Chronic Care Management, a critical component of primary care that contributes to better health and care for individuals. CCM allows healthcare professionals to be reimbursed for the time and resources used to manage Medicare patients’ health between face-to-face appointments.