Doc-with-dollar-sign-200px-150x141As the new Chronic Care Management code program is rolled out, providers have raised multiple questions that have yet to be answered about reimbursement for the code. One of the questions that have arisen in our recent webinars on the new program was whether the Chronic Care Management code would be covered under other programs such as Medicare Advantage.

Currently, as we understand it, chronic care management is only covered for fee-for-service Medicare patients.

This question has apparently been raised in other venues as well. At a recent educational session, CMS representatives were asked whether Medicare Advantage plans had to recognize the code.

The answer: The question needed to be “vetted further” by CMS Medicare Advantage staff.

In response, the AAFP recently announced that they have requested clarification on this issue, urging CMS to specify that all Medicare Advantage plans recognize and provide reimbursement for the CCM.

“Elderly and disabled patients (who) receive coverage through Medicare Advantage plans should have equal access to benefits available to beneficiaries receiving health insurance coverage through traditional Medicare,” said AAFP Board Chair Reid Blackweider, M.D., in a March 5 letter to CMS Deputy Sean Cavanaugh.

No response from CMS has been made available as of yet.

Other Medicare Advantage questions

Blackwelder also addressed two other issues for the Medicare Advantage program. The first was the need for valid provider directories, saying they are critical for addressing accessibility issues for Medicare Advantage. Second, Blackwelder urged CMS to require standardization of provider directories so the only information collected and updated would be the provider’s name, practice location, phone number, website, office hours and other information regarding provider availability.

Citing the possible changes in a physician’s willingness to accept new Medicare Advantage patients, Blackwelder said that the process should be streamlined: “The MAO’s (Medicare Advantage organization) website for physicians should have a check-box feature that is easily accessible for them to check,” he wrote.

We will keep you posted on any additional information regarding Chronic Care management coding and the Medicare Advantage program as it becomes available. If you missed our recent webinar on “How to Get Paid for the New Chronic Care Management Code,” you can watch it now. You can also find additional white papers and infographics in our Resource Center on topics including Chronic Care Management coding, Medicare Advantage HCC coding, and more.