Chronic Care ManagementFinally, some good reimbursement news for primary care physicians: CMS has announced a new chronic care management program starting in 2015 that will allow you to bill for providing care management for your patients with chronic conditions.

In other words, you can get paid for doing things you likely already do.

With this new code, chronic care management can provide a good source of revenue for your practice, if designed, managed and billed correctly. Since a provider can bill $41.92 per patient per month, if you have a number of patients with chronic conditions, you could easily see revenue of up to $50,000 per year.

Annually: $503.04 per year per patient X 100 patients = $50,304 per year

(Assumes you bill 12 months out of the year)

But—there are very specific things you need to know about the program, and particular requirements you need to follow in order to get paid. Here is a preview of some of the things you need to do:

  1. You will need to identify your chronic care patients who qualify.
  2. Eligible patients include those with two or more chronic conditions expected to last at least 12 months, or until death, that place the individual at significant risk of death, acute exacerbation/decompensation, or functional decline.
  3. Only one provider can bill for the chronic care management code in a 30-day period.
  4. You must have a signed agreement with the patient allowing you to bill for these services and detailing cancellation rights, copayments and types of services.
  5. Among other things, you need to provide 20 minutes or more of chronic care management services per patient per 30 day billing period.
  6. You will need to create a patient-centered care plan document compatible with the patient’s choices and values.
  7. You must provide either a written or electronic copy of the care plan to the patient.
  8. You will need to manage care transitions between and among health care providers and settings.
  9. Bill in accordance with CMS requirements using a yet-to-be assigned G-code, making sure your EHR software provides the information you need to manage and bill for this program.
  10. Begin the process of establishing your processes and gathering patient agreements soon, although the program doesn’t go into effect until 2015.

What Your EHR Software Should Do

1. Your EHR needs an interface that creates a virtual list of all your patients that have FFS Medicare and at least 2 Chronic Conditions

2. Next your EHR must narrow that list of patients “real-time” to ones that:

  • Have had activity outside of an in-person or telemedicine encounter with the patient
  • Have a signed CCM patient agreement incorporated into the medical record

3. Finally, your EHR must have a way to create bills with the new G-Code automatically for each 30-day period for every eligible patient. It must track whether the code was already billed during the 30-day period and also remind you to bill the service for eligible patients before the billing period expires.

We believe this program is a step in the right direction. Chronic diseases are among the most prevalent, costly, and preventable of all health problems, as the CDC has pointed out. Multiple studies have shown that care management of this type reduces total costs of care for patients with chronic conditions while improving outcomes. And certainly, the population of patients with chronic conditions only continues to increase. But historically, providers were not reimbursed for care management that was not face-to-face.

Get started now on your chronic care management coding program; learn the requirements, begin establishing your processes and identifying appropriate staff, and make sure you get paid for this important care.

Get your free step-by-step guide to getting paid under the new Chronic Care Management Code now.

MediTouch is the only EHR software that offers you an in-system feature that makes it easy to manage your chronic care management coding. Request a free online demo of this exciting new feature now.