Chronic care management (CCM) provides patients with two or more chronic conditions the ongoing care they need to live as healthy of a lifestyle as possible. While the focus of these services is giving patients quality care, compensation is also an important concern for healthcare providers. Following the Centers for Medicare and Medicaid Services (CMS) chronic care management guidelines ensures that healthcare teams adhere to billing protocols and best practices. Acknowledging that this is a complex process, TimeDoc created this blog to offer additional insight into some Medicare chronic care management regulations.
Which Conditions Are Considered Chronic by CMS?
The CMS considers 21 different conditions to be chronic afflictions. Of the ones on that list, these are some of the top conditions that Americans face today:
- Alzheimer’s Disease: In 2020, 5.8 million Americans had this condition. It’s estimated that 14 million will have it by 2060.
- Cancer: This condition is the second leading cause of death in the U.S. One in three people will be diagnosed with cancer in their lifetime. Cancer treatment costs the healthcare system $185 billion a year.
- Diabetes: 37.3 million Americans have diabetes, and 96 million have prediabetes. Treatment for this condition costs the U.S. healthcare system $327 billion a year.
- Heart Disease: This condition is the leading cause of death in the U.S., taking the lives of one in three Americans each year. Heart disease costs the healthcare system $216 billion a year and $147 billion in lost productivity at work due to premature death.
- Stroke: Even though this condition is one of the leading causes of death in the U.S., it’s also preventable and treatable. The chance of having a stroke doubles every 10 years once you reach the age of 55.
For a patient to be eligible for CMS CCM, they must have at least two of these conditions for at least 12 months or until their passing.
What Is Required to Bill CCM?
In addition to treating patients with at least two long-lasting chronic conditions, other CCM billing requirements include:
- You provide patients with a care plan that includes information on their conditions, expected outcome and prognosis, treatment, and more.
- The patients give consent before you provide them with services.
- You record each patient’s health information in an electronic health record (EHR).
- You provide at least 20 minutes of care to the patients each month.
- You call patients to check in with them between scheduled appointments.
- Patients have access to medical support 24/7 in case they have an urgent medical need.
While all these requirements will give patients the care they need to maintain a healthier lifestyle even with multiple chronic conditions, they can place a toll on healthcare providers. It can put extra work on their plates. TimeDoc Health’s platform and services relieve some of that strain by offering you the tools and staff you need to take care of a patient in less time. Plus, our platform helps you maintain Medicare compliance by giving you a place to store monthly encounter summaries, consent forms, and care plans.
Who Can Make Chronic Care Management Calls?
The CMS recognizes that providers are busy and cannot always be the ones to make CCM calls, so they do permit others from your clinical staff to assist. Care coordinators like those who work with TimeDoc Health can make these calls and work as an extension of your team if your staff doesn’t have the time or if you don’t have the staff. Healthcare providers must supervise these calls or any other services that the clinical staff gives. That does not mean that they have to be physically present. Rather, it means they direct what is done or said and the CCM care is billed under their national provider identifier (NPI). Such providers may be one of the following:
- Physician
- Advanced practice registered nurse
- Physician assistant
- Clinical nurse specialist
- Certified nurse midwife
Even if you don’t need extra personnel to make the calls for you, a platform like TimeDoc Health makes it easy to schedule telehealth calls and to share information via the EHR.
Who Can Bill CCM Codes?
The only people who can bill for CCM codes are those we listed in the previous section. It’s important to note that only one provider can bill for CCM per month. Although only one provider is allowed to bill for CCM each month, other clinical staff are not prohibited from providing CCM services.
Due to the monthly billing rule, additional treatment sessions must be billed under codes separate from the CCM CPT codes. To help you understand how you might bill CCM treatment, here are a few of the different codes used:
- 99490: The most common code you’ll use. It covers the 20 minutes or more that clinical staff spends coordinating or providing care to a patient.
- 99439: An add-on to 99490 for an additional 20 minutes spent coordinating or providing a patient with care.
- 99491: This code is similar to 99490. It only differs in that the provider is the one contacting the patient, and that contact lasts for at least 30 minutes.
- 99437: An add-on for 99491 for an additional 30 minutes of care given by the provider.
- 99487: This code is used for complex decision-making when the provider gives care for at least 60 minutes in one month.
- 99489: An add-on to 99487 for an additional 30 minutes of care given by the provider or clinical staff.
TimeDoc Health’s integrations and automations make CCM billing much more manageable by saving you time on the process.
TimeDoc Health: CCM Billing Made Easy
With TimeDoc Health, you can easily track how much time you spend providing CCM to each patient through our advanced EHR integrations. You do so without interrupting your work by automatically tracking and logging your time in patient charts. Our platform will also streamline your billing processes by automatically tabulating charges based on the activities your team documents in the EHR.
To learn more about how our platform and services can assist you with your CCM program, schedule a demo.