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.
With the publication of the 2017 Medicare Physician Fee Schedule Final Rule, Medicare reaffirmed its commitment to reimbursing for CCM. Providers can continue billing for CCM services using CPT code 99490, so long as they satisfy the program’s core requirements:
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.
Document Written Consent
Electronically capture patient consent anytime, anywhere, on any device; automatically import a signature into the chart.
Use a Certified EHR
Compliant with 2011 or 2014 editions of the certification criteria for EHRs.
Maintain an Electronic Care Plan
Certified EHR supplies the care plan (provide care plan electronically to patient; allow patient to add to the care plan; import new/revised information into the chart).
Ensure Beneficiary Access to Care
Relates to 24/7 access to eligible providers (no technology requirement).
Facilitate Transitions of Care
Manage and track transitional care management steps and programmatically define care team follow-up.
Coordinate care delivery across the team and enterprise through automated programs and workflows.
20+ Minutes of Non-face-to-face Care
Track, audit, and report CCM-related activities; integration with practice management and billing systems for reimbursement.
Configurable, Protocol-Driven Workflows
Enli's CCM program relies upon a technology foundation that incorporates prepackaged rules and workflows, which can be uniquely configured to support the individual requirements of physician practices, as well as existing systems of record. The combination of integration and automation enables provider organizations to cost-effectively scale CCM programs.
"We're already beginning to evaluate opportunities to leverage and extend the infrastructure and process to address other value-based programs and initiatives."
- Barry Allison, Chief Information Officer, The Center for Primary Care
To learn more about Chronic Care Management, download and read this white paper.White Paper
To hear what one CIO has to say about CCM and the role of technology in transitioning to value-based care, watch this brief video.Video
Medicare is reimbursing physicians approximately $43 per eligible beneficiary per month-that's about $500 for each patient over the course of the year.
Use our CCM Revenue Calculator to gauge the financial impact on your practice.Calculator
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.
Download and read a summary of the survey findings.Survey