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chronic-care management

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Don’t lose those CCM dollars



Nearly two years after the Centers for Medicare & Medicaid Services (CMS) launched CPT code 99490, many physician practices, especially smaller ones,  still haven’t  launched chronic care management (CCM) programs, thus giving up a lot of money.

CMS says that of the 35 million Medicare patients eligible for CCM programs, the agency has only received reimbursement requests for about 100,000 patients.

What might be scaring the practices: A CCM program can be resource- and labor-intensive to start and  patients may bear some costs  in the form of co-pays for services provided between point-of-care visits.

Still,  for a practice not to launch risks losing  it tens of thousands of dollars per month in value-based reimbursements as Medicare payment reform and its Merit-based Incentive Payment System (MIPS) goes into effect soon (unless the Trump administration gets in the way). And, Medical Economics notes, many of the feared challenges to launching a CCM program can be overcome at relatively modest costs and effort with the help of a partner.”

To read the Medical Economics article on this, please hit this link.

A bonanza from chronic-care management


Medscape has this happy news:

“The new rule from the Centers for Medicare & Medicaid Services (CMS) allowing reimbursement for chronic care management (CCM) is a huge change that could create much more revenue for many physicians—enabling some practices to get paid for work they’re already doing, and others to add services that will increase their revenue and improve patient care.

“This means that making phone calls, helping patients fill out insurance forms, consulting with patients about medication over the phone, and taking calls from patients during evenings or weekends may all count toward billable activities, under the CCM code (99490) that went into effect on January 1, 2015.”

To read the Medscape article, please hit this link.

How to get paid for chronic-care management


This article in Modern Healthcare explains why most physicians don’t put in for Medicare’s chronic-care management fee but also how some doctors are making it work.

Since last January, the Centers for Medicare & Medicaid Services has reimbursed physicians for monthly expenses for chronic-care management of patients not conducted during a patient’s face-to-face visit with a physician.

The publication reports:

“Complaints about the chronic-care management reimbursement program vary from lengthy documentation to having to have a difficult conversation with patients who now are responsible for a 20% copayment for previously free services.

“Primary-care advocates hoped the care-management fee would transform some practices, encouraging them to invest in infrastructure and adopt a team-based model of care.”

But the numbers so far are very disappointing.

Still, the magazine, offering a few good examples of practices dealing with the reimbursement issue, holds out hope:

“Practices that approach care with a team effort have an easier time fulfilling the requirements needed to obtain reimbursement for chronic-care management.”




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