CHRONIC CARE MANAGEMENT

A Bridge to Value-Based Care

The Centers for Medicare and Medicaid Services (CMS) reimburses providers who actively manage care delivery for Medicare patients suffering from two or more chronic conditions. The program, known as Chronic Care Management (CCM), was designed to help participants build the competencies required to succeed in value-based care and reimbursement.

In its update to the 2017 Medicare Physician Fee Schedule, CMS streamlined CCM billing rules to reduce regulatory complexity and added new billing codes. Providers must furnish certain CCM information to beneficiaries, deliver five core care management services, and provide at least 20 minutes of follow-up outside of the office (i.e. non-face-to-face care). The financial upside, however, can be significant—potentially doubling practice billings.

CCM Requirements

CCM Requirements core requirements icon

Furnish Program Information

Providers must document in the medical record that certain information regarding CCM was furnished and that the beneficiary consented.

Have Five Specified Capabilities

  • Use a certified EHR
  • Maintain an electronic care plan
  • Ensure beneficiary access to care
  • Facilitate transitions of care
  • Coordinate care

Provide Monthly Services

  • 20+ minutes of non-face-to-face care management services per calendar month
  • Clinical staff must deliver services under the general supervision of a physician.

To account for additional time spent by clinical staff delivering CCM services, CMS introduced new billing codes in 2017.

CPT 99358

For prolonged E/M service (the first 60-minutes) in which a physician spends significant time outside of the usual office visit addressing a patient's needs.

CPT 99359

An add-on code for prolonged E/M service, billed in 30-minute increments beyond the initial 60 minutes.

Who's Eligible?

providers icon
patients icon
Enli's cloud-based, EHR autonomous solution enables provider organizations to address key CCM program requirements, including documentation, care plan maintenance, transitional care management, care coordination, and care team time tracking to facilitate billing.

Enli's cloud-based, EHR autonomous solution enables provider organizations to address key CCM program requirements, including documentation, care plan maintenance, transitional care management, care coordination, and care team time tracking to facilitate billing.

document written consent icon
certified ehr icon
electronic care plan icon
beneficiary access to care icon
transitions of care icon
coordinate care icon
non-face-to-face care icon
Customer Perspective The Center for Primary Care (CPC) is a family medicine practice that offers comprehensive healthcare services, including personal care, acute care, and chronic care management to approximately 24,000 Medicare patients. The practice has 39 physicians who work in seven offices located throughout Georgia and South Carolina.

Customer Perspective

The Center for Primary Care (CPC) is a family medicine practice that offers comprehensive healthcare services, including personal care, acute care, and chronic care management to approximately 24,000 Medicare patients. The practice has 39 physicians who work in seven offices located throughout Georgia and South Carolina.

Interested in Learning More?

Interested in Learning More?

white paper icon
CCM video icon
revenue calculator icon
Healthcare IT News webinar icon
HIMSS webinar icon
National Chronic Care Management 2015 Survey icon
To hear what the experts are saying about chronic care management, replay this CCM Virtual Town Hall moderated by Healthcare IT News.

Webinar
HIMSS Media produced and hosted "A Practical Guide to Chronic Care Management." Watch the recorded webinar to learn more about the clinical and financial case that underlies CCM.

Webinar
Together with PYA, Enli Health Intelligence developed the National Chronic Care Management 2015 Survey to capture provider attitudes, intent, aspirations, and experience with CCM; identify the types of organizations that are embracing CCM; and gain an understanding of the obstacles to CCM adoption.

Survey

Have a question? Visit our Frequently Asked Questions