On January 1, 2015, CMS began reimbursing providers billing for CPT code 99490 $41/month per Medicare patient with two or more chronic conditions for 20 minutes of non-face-to-face care coordination. In the 2017 Medicare Physician Fee Schedule Proposed Rule, CMS recommended some changes to the current chronic care management billing rules. Billing for Chronic Care Management may not be as straightforward in the future as it is now, as CMS is proposing to introduce some new codes, including codes to address behavioral health integration and encompass the psychiatric collaborative care model. However, CMS claims that the ultimate goal is to actually simplify chronic care management, making it easier to provide these services by implementing the following:
Eradicate the need to require a consent form.
Currently: In order to bill for CCM for a specific patient, a provider must secure that’s patient’s signature on a chronic care management patient agreement, stating specified content.
Proposed: The billing provider may document in the medical record that certain CCM activities were furnished to the patient, instead of obtaining a signature.
Initiating visit rules would be relaxed.
Currently: The billing provider must initiate CCM with a patient during a face-to-face evaluation and management visit.
Proposed: An initiating visit is only required for new patients or patients not seen within 12 months.
That providers have 24/7 access to patients’ records.
Currently: Each patient participating must have a means to make timely contact with members of practice staff who have access to the patient’s electronic care plan.
Proposed: The rule regarding access to the beneficiary’s care plan would no longer be a requirement.
That certified EHRs be used to share clinical-care summaries when moving patients from one provider to another.
Currently: Providers must share each CCM patient’s clinical care summary with other providers involved in that patient’s care plan via certified EHR.
Proposed: These clinicians will be required to share records with other clinicians in a timely manner via any desired method.
CMS also proposes to make payment for complex CCM (CPT code 99487), which follows the same billing rules, except that complex CCM requires 60 minutes of non-face-to-face care as opposed to 20 minutes, and has made several proposals relating to behavioral health integration, like we mentioned.
Remember that participating in Chronic Care Management now will likely help your MIPS score down the road, as we move towards value-based and coordinated care models.