Providers who are willing to allocate 20 minutes a month to the management of Medicare beneficiaries with multiple chronic diseases can generate incremental revenues while expanding their population health management (PHM) capabilities.
Medicare’s chronic care management (CCM) program is one of several revenue enhancement opportunities proffered by CMS to encourage healthcare organizations to invest in PHM while they are still primarily reliant on fee-for-service (FFS) revenue. The CCM code allows providers who devote 20 minutes a month to coordinating care for each eligible Medicare beneficiary to bill for their efforts. The code only applies to non-face-to-face encounters.
Depending on the composition of a practice’s patient panel, 20 minutes per eligible Medicare beneficiary, can add up to a material investment of time and effort quickly. But so can revenue – and the impact on patient outcomes.
What it Entails
Activities allowed in the required 20 minutes include:
- Monitoring patient care plans (e.g., management of chronic conditions, medication reconciliation, ensuring receipt of preventive services)
- Reviewing test results
- Consulting the patient’s other providers
- Following up with the patient via phone after ER visits
To successfully bill the CCM code, providers must obtain patients’ consent to participate in the program. Each participating patient must also agree to pay a modest monthly co-payment.
Patient Eligibility
Patients who are eligible for CCM services must have two or more chronic diseases that are expected to last at least 12 months. These conditions may include:
- Alzheimer’s disease and related dementia
- Arthritis
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer
- Chronic obstructive pulmonary disease
- Depression
- Diabetes
- Heart failure
- Hypertension
- Ischemic heart disease
- Osteoporosis1
Advantages
As with the transitional care management program discussed in a previous post, the CCM code presents a real financial opportunity for providers. When CMS introduced it in 2015, it estimated that approximately 35 million Medicare beneficiaries – nearly two-thirds – would be eligible to receive these services. At upward of $41 per member per month (depending on the market), delivering and appropriately billing for CCM services could lead to substantial revenue.
Equally important, participating in CCM activity helps providers establish a foundation for PHM. With MACRA looming, organizations that still rely heavily on FFS billing need to start developing PHM competencies. CCM is one of several programs that can function as a bridge to population health.
Below are some of the challenges PCPs often encounter when implementing CCM services, along with tactics to overcome them.
To learn more about the TCM program and other programs that can serve as a foundation for value-based care, check out Building a Fee-for-Service Bridge to Population Health in the November 2016 issue of hfm.
| Challenges | Tactics |
|---|---|
| Obtain patient consent and collect an $8 monthly co-payment. | 90% of Medicare patients have supplemental coverage, which can be used to cover the co-payment. Stress the value of additional care for CCM to patients with multiple chronic diseases. |
| Identify eligible patients. | Use analytic systems to create a cohort of eligible patients based on disease criteria. Prioritize those patients by risk. |
| Establish an efficient work flow. | Hire a care coordinator and build a work flow to guide CCM activities. Establish an efficient sign-off process for supervising providers who bill the service. |
| Appropriately document non-face-to-face time to meet billing requirements. | Working with IT staff and the billing office, ensure documentation standards are built into the care coordinator’s work flow. |
| Coordinate with other providers and activities as appropriate. | Establish organizational policies around program implementation to determine which providers will be billing CCM. Maintain open communication channels with the billing office to ensure coordination between providers and other programs. |
Footnotes
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Published January 4, 2017