Medicare’s shift towards value-based care means the traditional model of health care reimbursement has just had a major shakeup. With value-based care, providers’ payments are now based on the value of care physicians deliver to patients and their health outcomes.
Patients with chronic conditions often require greater care outside of the office. Beginning Jan. 1, 2015, The Centers for Medicare & Medicaid Services (CMS) began paying for Chronic Care Management (CCM) services. Requiring at least 20 minutes of non-face-to-face care, providers receive an average reimbursement of $42 per patient per month with two or more chronic conditions. CCM has grown in popularity and many providers are seeing the increase in revenue. However, a number of physicians are still struggling to incorporate chronic care management into their practice. While the CMS requirements of CCM may be overwhelming, chances are many physicians are already managing Medicare patients with two or more chronic conditions and not getting the extra reimbursement to help with the added care.
The 2017 Medicare Physician Fee Schedule rule was finalized on Nov. 2, 2016. Providers will see payment changes for care management services in 2017. There are several changes that CMS has proposed regarding chronic care management. These changes are set to make billing rules within CCM simpler as well as expand the payment for complex CCM, including patients with behavioral health conditions. The new fee schedule rule will offer a new set of codes for providing care management to those patients.
Highlights from the 2017 Medicare Physician Fee Schedule regarding CCM
- Simplification of CCM billing rules
- Payment for complex CCM patients (CPT code 99487)
- Supervision requirement change for CCM by Rural Health Clinics (RHC) and Federally Qualified Health Clinics (FQHC)
- Pay for non-face-to-face extended E & M services
Part of the simplification of the CCM billing rules means the possibility of no longer requiring a consent form from the patient, but rather the provider would simply document in the patient’s medical record that CCM information was provided to the patient. Another benefit of this final rule is that initiating visits no longer have to be face-to-face office visits, unless the patient is considered a new patient or the patient has not been seen within the year prior to commencement of CCM. However, if providers do initiate CCM on a face-to-face visit, they can use the new GPPP7 to bill for that visit and receive a higher payment of $63.68.
Along with these changes to CCM for 2017, there is also a 3.5 percent increase in the CCM payment rate for 2017. The current rate in 2016 for CPT code 99490 is $40.82. This increase would make the 2017 rate $42.21. For complex CCM payments (CPT code 99487), the proposed rate for 2017 is $92.66. The complex CCM, CPT code 99487 requires 60 minutes of non-face-to-face care per month. CMS has also proposed an add-on code for complex CCM (CPT 99489) for each additional 30-minute increments of non-face-to-face time, at a proposed 2017 rate of $46.87. Please note: reimbursement rates vary by region.
MediSYS has outsourced full-service CCM to ease the burden on providers of meeting the CCM requirements while saving providers time and resources to enhance patient care.
“Providers have been very responsive to outsource chronic care management services because of the additional help they receive that saves them time and brings in additional revenue,” explained Jennifer Woodward, director of operations with MediSYS.
Outsourcing your CCM solution can help you increase revenue and expand patient satisfaction as well as provide you better patient access through a broader clinical depiction. CCM will also prepare providers for 2017 and the changes that MACRA has implemented in the healthcare industry to improve patient care and focus on value-based quality goals.
“With MIPS starting next year, providers are working hard to prepare for the changes that coming. By outsourcing this portion of the program, it provides them more time to work on the other aspects of the quality payment program to report effective care coordination,” Woodward said.
For information on MediSYS electronic health records and practice management solutions as well as outsourcing CCM services, please contact MediSYS at firstname.lastname@example.org and visit the website at www.medisysinc.com. MediSYS is an official partner with the Medical Association.