In its annual review of billing requirements, the Centers for Medicare and Medicaid Services (CMS) recently announced proposed changes that will expand the codes physicians can use to get reimbursed for Chronic Care Management (CCM).

“These policies will give significant support to the practice of primary care and boost the time a physician can spend with his or her patients listening, advising, and coordinating their care,” CMS Acting Administrator Andy Slavitt said in a press release.

In a separate blog, Slavitt and Patrick Conway, MD, acting principal deputy administrator and chief medical officer for CMS wrote, “We’ve discussed a number of times how our country’s healthcare system historically invested far more in treating sickness than maintaining health. This imbalance contributes to more spending on institutions, hospitals, and nursing homes, rather than keeping people healthy at home and in their communities. By better valuing primary care, care coordination, and prevention, we help people access the services they need to stay well.”

In the 2017 proposed rule, CMS is proposing the following changes to CCM coding and related payment policies:

  • New coding, including three codes to describe services furnished as part of the psychiatric collaborative care model (CoCM) and one to address behavioral health integration
  • Improved payment for cognition and functional assessment, and care planning for beneficiaries with cognitive impairment
  • Payment adjustments for routine visits furnished to beneficiaries whose care requires additional resources due to their mobility-related disabilities
  • Medicare payment for complex CCM services, and payment adjustments for the visit during which CCM services are initiated, to reflect resources associated with the assessment for, and development of, a new care plan
  • Medicare payment for non-face-to-face prolonged evaluation and management (E/M) services by the physician (or other billing practitioner) that are currently bundled, and a payment rate increase for face-to-face prolonged E/M services by the physician (or other billing practitioner) based on existing American Medical Association/Specialty Society Relative (Value) Update Committee recommendations

CMS estimated that the new codes for CCM and other patient-centered care services eventually could increase payments to geriatricians, internists, and family physicians from 30 to 37 percent.

Regarding the administrative requirements of CCM and CPT Code 99490, CMS noted in the final rule, “Practitioners have stated that the service elements and billing requirements are burdensome, redundant and prevent them from being able to provide the services to beneficiaries who could benefit from them.”

Since establishing code 99490 in 2015 to pay for up to 20 minutes each month to manage the care for patients with multiple chronic conditions, CMS reports that about 513,000 unique Medicare beneficiaries received the service an average of four times each, resulting in $93 million in total payments.

Recognizing some of the administrative difficulties of delivering CCM services, a new breed of CCM service providers have stepped in to fill the gap. These are third party companies that set up a CCM training, billing, and service delivery infrastructure that practices can tap into to deliver CCM services without having to build their own technology and therapeutic systems.

Universal Medication Management provides an advanced platform for patient care management for individuals and their family members or personal caregivers that ensures safe, effective, and appropriate use of prescriptions needed for self-care, acute care, or chronic care management.

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