An estimated 117 million adults have one or more chronic health conditions (CMS)
One of the current “buzz terms” in healthcare is Chronic Care Management (CCM). You’ve likely heard of it and probably have the impression that it’s a great way to better manage patients’ health while also earning some extra revenue. But should you participate? Can you participate? Here’s what you need to know about CCM.
What is Chronic Care Management?
By definition, the Chronic Care Management model involves services provided by a clinician and their clinical staff over the course of a calendar month for patients who have “multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline”. Chronic Care Management services are provided apart from and in addition to in-person visits and center on attributes of advanced primary care including providing the patient an ongoing relationship with a designated clinician, offering 24/7 access to health information and patient care, giving support to patients with chronic diseases as they work to achieve health goals, sharing and utilizing health information in a timely fashion, and engaging patients and their caregivers in their care plan.
How does billing work?
Clinicians and clinical staff track the time spent providing CCM services for each individual patient throughout the calendar month. Once a given patient has reached at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional dedicated to management of their chronic conditions, the clinician can bill for Chronic Care Management services using CPT 99490 for that month. If a patient has received a minimum of 60 minutes of clinical staff time in a calendar month and that time includes substantial work to a comprehensive care plan or moderately to highly complex medical decision making, the clinician can bill for Complex Chronic Care Management services for that month using CPT 99487. It’s important to note that a clinician cannot bill for both complex and non-complex CCM services for one patient in one month and only one provider can bill for CCM services for a given patient in a given month.
How do I get started?
In order to start providing Chronic Care Management services for a patient, a clinician should first obtain consent for CCM services for that patient in order to ensure the patient is engaged in the process and understands what they can expect from their provider as well as their right to stop CCM services at any time, effective at the end of the calendar month. Obtaining advance consent is also helpful in preventing duplicate billing for a patient as they are advised that only one practitioner can provide these services to them and they can make a clear choice as to who that provider should be for their particular circumstance.
In addition to obtaining consent, providers are required to conduct in-person initiating visits with all new patients and patients who have not been seen within the year prior to the start of their CCM relationship with their provider. This visit is separate from CCM services and, as such, is billed separately.
What role does Health IT play?
Recording of patient health information such as demographics, problems, medications, and allergies is an important part of Chronic Care Management and as such it is important to use a certified EHR.
MicroMD EHR includes a CCM module in version 13.5.2 that allows practices to easily track patients who are utilizing CCM services, record their non-face-to-face time, and then automatically bill for that time once the cumulative time in a calendar month reaches 20 minutes. The care team is able to record this non-face-to-face time from a single dashboard located conveniently on their desktop in MicroMD EHR, eliminating the need to create an encounter or even open a patient’s chart.
The Chronic Care Management (CCM) model is a great way to provide better patient care while increasing revenue. With the right EHR, tracking and billing for CCM services is efficient and easy.