What is Chronic Care Management(CCM)?

 

CCM is a Medicare reimbursement program for managing care for beneficiaries with multiple chronic conditions. Medicare Fee for Service beneficiaries with 2+ chronic conditions expected to last at least 12 months are eligible. It includes CPT 99490 – a monthly reimbursement for 20 minutes of clinical staff time spent on non-face-to-face care coordination per patient. The non face-to-face time can be provided by any clinical staff members, including external care managers.

Stand alone service are included as part of RPM Plus CCM patients.

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           ◾ Learn how to implement a sustainable and scalable CCM program at your practice

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Patient Benefits

◾ More accessible care - More access to their primary care provider. A monthly communication and review of health that ensures medication adherence and monitoring.

◾ More immediate care - Communicate changes in health status directly to the medical provider. Provides access to medical records and provides shared decision making between both the patient and the provider. Provides a dynamic care plan that is up-to-date and relevant to the patient condition.

 

Provider Benefits

 

◾ Promotes coordinated and comprehensive care while individualizing patient-centered care plans.

◾ Reduces crisis-like care through ongoing communication and proactive disease management.

◾ Promotes coordinated and comprehensive care outside of the clinical setting.

◾ Increases monthly reimbursement

Outsourcing CCM

Allows for outsourcing and reduces the need for :

◾ Staff training and time away from demands of the practice

◾ Billing and reimbursement coding and knowledge

◾ Hiring designated care coordinators

◾ Budgeting for specialized staff and technology to meet the requirements of CCM

◾ An inability to manage an unpredictable variation in patient volume

CCM CPT Codes:

 

     ◾ 29490

 

         ◾ 2017 – relaxed service elements & billing requirements

         ◾ 20 minutes / month

         ◾ $42.84

 

     ◾ Complex CCM

 

         ◾ 29487 – 60 minutes/month

                 ◾ $94.68 (national)

         ◾ 29489 – add on – 30 minutes / month (after 1st60)

                 ◾ $47.16 / $26.56

         CCM Initiating visit – G0506

                 ◾ Add-on – face-to-face

 

What Activities Count Towards CCM Time?

 

Any non-face-to-face care management and coordination service provided on behalf of an enrolled beneficiary by a clinical staff member or provider counts.

 

Care Management:

 

         ◾ Phone calls, emails and messaging with the patient and caregiver (+10 minutes)

         ◾ Lab, report, and image review (+5 minutes)

         ◾ Care plan creation, revision, and review (+20 minutes)

         ◾ Chart documentation

 

Care Coordination:

 

         ◾ Referring to and consulting with other providers, reviewing consult notes (+10 minutes)

         ◾ Communicating with home/community providers

         ◾ Post-discharge follow-up

         ◾ Medication refills and medication reconciliation (+5 minutes)

         ◾ Drug and other prior authorizations (+10 minutes)