Chronic Care Management Information - Information, Management Services, and Solutions

About Chronic Care Management

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1 About Chronic Care Management

1.1 What Is Chronic Care Management?

1.2 Who Can Provide Chronic Care Management?

1.3 Who Is Eligible for CCM?

1.4 How Does CCM work?

1.5 How Does Chronic Care Management Benefit Patients?

1.6 What are the Chronic Care Management Billing Codes?

1.7 How Does CCM Support Medicare Reimbursement?

1.7.1 References

What Is Chronic Care Management?

Facing the rapid rise in healthcare costs, in 2015 Medicare introduced a means to counteract the health effects and costs of chronic conditions. Chronic Care Management (CCM) oversees ongoing medical problems that patients and their care providers must manage effectively to maintain the best possible health and avoid unnecessary hospitalizations. With CCM, patients with two or more chronic conditions receive monthly care from a medical practitioner or clinical staff by telephone or video conference. These interactions assist people in managing their conditions, and provide additional care coordination and engagement between office visits. The service is billable to Medicare by the provider, and paid by the patient’s Medicare supplement.

Chronic care management is care coordination services done outside of the regular office visit for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient. These conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services are typically non-face-to-face and allows eligible practitioners to bill for at least 20 minutes or more of care coordination services per month.⁶

Who Can Provide Chronic Care Management?

Only physicians and certain medical practitioners (physician assistants, clinical nurse specialists, nurse practitioners, and certified nurse midwives) can bill Medicare for CCM services. However, the physician or practitioner may utilize other clinical staff, such as a pharmacist, registered nurse, or medical assistant, to provide chronic care management while under their general supervision. General supervision means the billing practitioner does not perform the service. Still, the service is under their overall direction and control, and the practitioner’s physical presence is not required. Only one practitioner may collect for a patient’s CCM services for a given calendar month.

Who Is Eligible for CCM?

Patients who qualify for chronic care management services include Medicare fee-for-service and dual-eligible (Medicare and Medicaid) beneficiaries with two or more chronic conditions.

How Does CCM work?

Chronic care management services require only a few simple steps to enroll the patient. First, the billing provider has to see the patient within the past year. (Although this visit is a required part of the CCM program, it is billed separately under the patient’s coverage schedule.) Then, the patient must sign a CCM enrollment consent form, which documents the availability and cost of the service, and the patient’s right to cancel the service.

Once the patient is enrolled, the chronic care management provider contacts the patient to thoroughly document the patient’s health information, including demographics, problems, medications, and medication allergies. The care coordinator uses this information to develop a care plan that is a personalized program defining the process and goals for treating the patient’s conditions. The care plan is connected electronically to the patient’s medical record at the physician’s office, so all notes, documentation, and urgent needs are accessible to the physician.

Following the care plan, the patient will receive a telephone or video call from the CCM provider once per month to discuss treatment, medications, changes, appointments, and other aspects of the patient’s care. In addition, the patient will have access to the chronic care management provider 24/7/365 to address urgent needs, regardless of the time of day or week. The care plan will continue to evolve as the patient’s needs change.

How Does Chronic Care Management Benefit Patients?

CCM is proven to help patients be more engaged in their health and reduce their medical expenses. Quantifiable benefits include reduced hospitalizations and ER visits, and fewer duplicate lab tests and X-rays.

Eligible patients enjoy the comfort and satisfaction of having a dedicated healthcare team overseeing their care; a person they regularly interact with and know can help them plan for better health and stay on track. The care coordinator monitors treatments, medication, referrals, and appointments through regular check-ins and reminders, and makes sure patients know and understand how to best care for their health and manage their conditions.

How is CCM paid?

Chronic Care Management is a billable service for Medicare beneficiaries with two or more conditions. There is no enrollment fee. Medicare covers the majority of expenses, with co-pays that patients’ Medicare supplemental policies may cover.

What are the Chronic Care Management Billing Codes?

CCM is covered under specific Medicare CPT Codes that depend on the type of service provided.

CPT 99490 – Chronic care management services, at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month
CPT 9949 – Chronic care management services, provided personally by a physician or other qualified healthcare professional, at least 30 minutes of physician or other qualified healthcare professional time, per calendar month
CPT 99487 – Complex chronic care management services, moderate or high complexity medical decision making, 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month
CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

How Does CCM Support Medicare Reimbursement?

CMS offers the physician myriad tools for participating in value-based care, including the CMS Chronic Care Management program.¹⁰CMS says,

“Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare or Medicaid. These programs are part of our larger quality strategy to reform how healthcare is delivered and paid for.” ¹¹

CCM provides physicians with another opportunity to improve the measures and metrics defined in the Medicare Quality Payment Program (QPP), including Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMS). These programs are intended to transition providers away from fee-for-service models towards value-based care.

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