What Is CCM?

In recognition of the importance of chronic disease management and the impact that it has on health care expenses and outcomes, the Centers for Medicare & Medicaid Services (CMS) has started paying monthly reimbursements for chronic care management (CCM) services.

 

Released on January 1st 2015, CPT code 99490 pays approximately $42 per month to providers who deliver 20+ minutes of non-face-to-face care management services to eligible Medicare beneficiaries with 2 or more chronic conditions. As quoted by the New England Journal of Medicine, “A physician caring for 200 qualifying patients could see additional revenue of roughly $100,000 annually.” The Final Rule of the 2015 Medicare Physician Fee Schedule included the new CPT 99490, defined as:

“Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements; multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.”

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What Activities Count Towards the 20 Minute Requirement?

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

The 20 Minute Requirement:

  • Phone calls, emails, and messaging with the patient and caregiver
  • Lab, report, and image review
  • Care plan creation, revision, and review
  • Medication reconciliation, overseeing patient self-management of medication
  • Chart documentation
  • Medication refills
  • Remote monitoring of physiological data
  • Referring to and consulting with other providers
  • Post-discharge follow-up
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Physicians and clinical staff members have always spent a significant amount of time on these activities, but haven’t been reimbursed for them, until now.

After over a year and a half of working with providers on Medicare's new CCM program, we've come to learn that there are two main obstacles to running a CCM program that is beneficial to both the practice and its patients.

 
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Technology

Health care organizations do not have the software functionality required to run an efficient and compliant CCM program at the scale necessary to generate significant value.

Staffing

For some organizations, existing clinical staff members do not have enough capacity to serve the volume of patients necessary to generate an attractive return on the investment.