Article contributed by: Tammie Lunceford, CMPE CPC with Warren Averett
Chronic Care Management Expands Care
Several years ago, the Center for Medicare and Medicaid Services released Chronic Care Management to assist in improving patient outcomes, extend care, and improve quality in chronic illness. The initial chronic care code, 99490 allowed for 20 minutes of non-face to face phone communication with clinical staff per month which reimbursed forty-two dollars per month. The patient had to agree to be enrolled in the program and agree to an $8 co-pay. Only one physician can enroll a patient and the patient must have at least two complex chronic conditions lasting more than twelve months. Most physicians did not adopt chronic care management due to the low reimbursement, the physician had to treat all chronic conditions which excluded most specialists from participating.
Some large practices outsource chronic care management and share the reimbursement. Whether the practice uses internal staff or outsourced staff, CCM services provide additional care and coordination to the most chronically ill. The patients receiving this service feel more connected to their provider and a change in their status is identified quickly. If the practice also has telemedicine, a non-face to face service can quickly become a face to face visit to address concerns. Due to the recent COVID-19 pandemic, these interactions could provide the care needed to protect the chronically ill from being exposed to the deadly virus.
The 2020 Final Medicare Physician Fee Schedule added some provisions to Chronic Care Management services. The addition of Principle Chronic Management allows a patient with a single high-risk chronic condition lasting more than 12 months to qualify for the program. PCM should increase the use of chronic care management with specialists, such as cardiologist and pulmonologists. Also approved for 2020, is G2058 which is an add-on code to allow an additional 20 minutes of time spent in continuous communication with the patient. The add-on code reimburses $37.89 and can be billed concurrently to 99490, two times monthly, per beneficiary. The total possible reimbursement for 60 minutes of non-complex CCM is $118.01.
The new opportunities to provide chronic care management and principle care management will allow specialists managing hundreds of patients with chronic conditions, such as, COPD or diabetes to improve the overall health of the patient, improve patient engagement, improve quality and receive reimbursement worthy of the effort.
Practices are currently working to provide many modes of communication to serve patients without seeing them in the office. Patient portals have failed in the past because many portals were not user friendly or practices failed to make them valuable by offering valid information through the portal. In times of crisis, such as COVID-19, it is quite possible for the phone lines to be full but utilizing the patient portal and offering CCM and PCM allows a practice to fulfill many patient’s needs without a physician or mid-level providing the interaction.
We are in crisis as COVID-19 cases increase across the nation, but we have seen monumental change through the emergency expansion of telemedicine. As administrators and physician leaders review the options to expand communication through technology and ongoing medical management, we will be better prepared for crisis situations in the future.