This article aims to provide a practical guide for CCM-focused care and its benefits. This guide will include the history of CCM, its future, potential barriers and opportunities for growth, and how to get involved.CCM means that Physicians are given a more structured way to track, prevent, and manage chronic conditions.

Chronic Care Management is a healthcare strategy that optimizes outcomes and reduces costs by focusing on preventing, early detection, and managing chronic illnesses. CCM has been shown to produce better health outcomes while reducing expenditures on care resources.

INITIATING VISIT

For new patients or patients who have not visited the practitioner within one year of time, Medicare calls for initiation of CCM offerings all through a face-to-face visit with the billing practitioner (an Annual  Wellness Visit [AWV] or Initial Preventive Physical Exam [IPPE], or different face-to-face visit with the billing practitioner. 

This initial visit isn’t always a part of the CCM provider and is one by one billed. Practitioners who grant a CCM initial visit  CCM care code may additionally cost HCPCS code G0506. G0506 is reportable as soon as according to the CCM billing practitioner, together with CCM initiation. 

PRACTITIONER ELIGIBILITY FOR CCM

Physicians and the subsequent non-Physician practitioners may also include CCM offerings:

  • Certified Nurse-Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physician Assistants 

CCM can be billed maximum often through number one care practitioners, despite the fact that on positive occasions, special practitioners may also offer to bill for CCM. The CCM provider is now no longer in the scope of exercise of limited-license physicians and practitioners together with medical psychologists, podiatrists, and dentists, despite the fact that practitioners may also refer or visit such physicians and practitioners to coordinate and manage care. 

PATIENT ELIGIBILITY

Patients with multiple ( or more) chronic conditions are anticipated to remain for at least 1 year or death of the patient, or functional decline, are eligible for CCM offerings.

Billing practitioners may identify patients who require CCM by offering CPT prefatory language. The billing practitioner can not record each complicated and regular (non-complicated) CCM for a given patient for a given calendar month.

A given patient gets both complicated and non-complicated CCM all through a given provider period, now no longer each. Examples of chronic conditions include, 

● Alzheimer`s disorder and associated dementia

● Arthritis (osteoarthritis and rheumatoid)

● Asthma

● Atrial fibrillation

● Autism spectrum disorders

● Cancer

● Cardiovascular Disease

● Chronic Obstructive Pulmonary Disease

● Depression

● Diabetes

● Hypertension

● Infectious sicknesses together with HIV/AIDS

Chronic Condition
Chronic Disease

Consent for CCM services guarantees the patient is engaged and cost-sharing. It may additionally assist save you duplicative practitioner billing. Consent can be verbal or written however should be documented withinside the clinical record, and consists of informing them about:

  • The availability of CCM services and relevant cost-sharing
  •  That simplest one practitioner can grant and be paid for the CCM program all through a calendar month

Informed patient consent wants simplest be acquired as soon as previous to furnishing CCM, or if the patient chooses to extrude the practitioner who will grant and invoice CCM 

 RECORDING OF PATIENT HEALTH INFORMATION

Record the patient`s demographics, problems, medications, and medicine allergic reactions using licensed Electronic Health Record (EHR) technology. This method is a model of licensed EHR this is perfect beneath neath the EHR Incentive Programs as of December thirty first of the calendar 12 months previous every Medicare PFS price 12 months. 

ACCESS TO CARE & CARE CONTINUITY

  • Provide 24-hour-a-day, 7-day-a-week (24/7) get admission to physicians or healthcare professionals or clinical staff, along with imparting patients (and caregivers as appropriate) with a method to make contact with specialists for emergency care
  • Ensure continuity of care with a selective member of the care group with whom the patient is capable of timetable successive recurring appointments
  • Provide improved possibilities for the patient and any caregiver to speak with the practitioner concerning the patient`s care through phone and additionally cure messaging, secure Internet, or different asynchronous non-face-to-face consultations

CCM Billing Code

 The billing practitioner can not file each complicated CCM and non-complicated CCM for a given patient for a given calendar month. 

CPT 99490

Chronic care management services, at the least 20 mins of the Clinical Staff Time time directed through a physician  or other health care expert, according to the calendar month

CPT 99491

Chronic care management services, provided by a primary care physician or other health care expert, at the least half-hour of Physician or healthcare professional time, according to the calendar month

CPT 99487

Complex care setting, with the subsequent, required elements:

  • Establishment of great revision of a complete care plan
  • Moderate or excessive complexity of clinical decision making
  • 60 mins of the medical staff time directed through a Physician or healthcare professional expert, according to the calendar month

CPT 99489

  • Each extra half-hour of the clinical staff time is directed through a Physician or other healthcare expert, according to the calendar month.
  • Complex CCM offerings of much less than 60 mins in duration, in a calendar month, aren’t stated one by one. 

You cannot bill 99491 within the same calendar month as 99487, 99489, or 99490. 

TRANSITIONAL CARE MANAGEMENT

● Manage transitions among the healthcare providers and settings, which includes referrals  to different clinicians, follow-up after an emergency hospital visit, or facility discharge

● Timely create and exchange/transmit continuity of care document(s) with different practitioners and carriers 

Medicare will not make duplicative bills for the equal or comparable services for patients with persistent situations already paid for below the numerous CMS superior number one care demonstration. Contact Us to Know more

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