.

Call Now 703-327-1800

Contact    Blog       About     Resources      Medical Billing Services

  

Chronic Care Management: 6 Tips for Documentation Success

Health Insurance Companies Process 1 in 5 Claims Wrong

 

ccm

As a medical billing company CEO,  I have heard lots of physicians and practice managers complain about time spent on non-billable services, like chronic care management. “My staff and I spend an awful amount of time helping patients over the phone; is there any way I can get paid for that?”

Physicians also want to know if they can be paid for services provided in between patient visits, such as completing forms, medication refills, and telephone consults. My response has always been “no”; there was no reliable way to get paid for these types of services. Now however, some of that has changed with Medicare’s new willingness to pay for Chronic Care Management Code 99490.

In this blog post, I’ll go over some rules and tips on how to document  for this service.

Take Advantage of the Reimbursement Opportunity

According to the CDC, one-third of the U.S. population has at least one chronic disease, such as cancer, asthma, diabetes or heart disease. Chances are good that we, or people we love, have experienced the challenges of coordinating care for these complex conditions.

CMS has a list of about 22 things the practice needs to do to comply, including engaging with each patient over the phone for 20 minutes each month to coordinate care. It doesn’t have to be one phone call, but could be a five-minute phone call each week, for example.

On these calls, clinicians find out what’s going on with patients and help them figure out what care they need and where they can get it. In return, CMS will pay about $40 per member, per month.

CMS Says

CPT code 99490 is defined as: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  • Comprehensive care plan established, implemented, revised, or monitored.

What constitutes a Chronic Condition?

According to the CDC, 66% of Medicare patients had two or more chronic conditions in 2015. Chronic conditions include:

  • Alzheimer’s and related dementia
  • Arthritis
  • Asthma
  • Atrial Fibrillation
  • Autism
  • Cancer
  • COPD
  • Depression
  • Diabetes
  • Heart Failure
  • Hypertension
  • Ischemic Heart Disease
  • Osteoporosis

Although this is not the complete list, practices see many patients with two or more of these diseases. So, it’s safe to say many medical practices have a large population of patients eligible for this service.

Key CCM Definitions:

Clinical Staff:  a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service; but who does not individually report that professional service.

Examples Include:

  • Medical Assistants
  • Nurses
  • Therapists

Directed by a Physician: CMS allows a physician to bill for this service so long as the service is provided under his/her general supervision. This means the physician is present and/or accessible during the time of service, and is able to guide the care. No direct contact between the physician and the patient is needed to bill this code.

Comprehensive Care Plan: according to CMS, a Comprehensive Care Plan includes the following:

  • Problem list;
  • Expected outcome and prognosis;
  • Measurable treatment goals;
  • Symptom management;
  • Planned interventions and identification of the individuals responsible for each intervention;
  • Medication management;
  • Community/social services ordered;
  • A description of how services of agencies and specialists outside the practice will be directed/coordinated; and
  • Schedule for periodic review and, when applicable, revision of the care plan.

These items should be documented in the patient’s chart prior to billing for the CCM code.

6 Tips for Documentation Success

1) Medicare requires that the patient understands and agrees to the chronic care management services before they are offered and billed. It may be best to draft a basic letter that the physician can review with the patient during their face-to-face visit prior to billing for the CCM. This letter should be signed by the patient and recorded in the patient’s record.

This letter should include:

  • An explanation of the CCM and its availability
  • An explanation that the patient can revoke the service
  • A portion explaining that only one provider can bill for this service for each patient
  • An explanation on what information may be shared between physicians

You can find tools & templates for CCM in the American College of Physicians CCM toolkit  (free) and the CCM Toolkit from the American Academy of Family Physicians ($69 for AAFP members).

2)  Medicare requires that an Annual Well Visit or Comprehensive Evaluation and Management code be billed prior to the CCM. During this first visit, document the discussion with the patient described above, his/her acceptance or denial, and the care plan that the CCM will follow.

3)  Consider building a template in your EMR/EHR that you or your clinical staff can use to document each CCM service. This template should copy over some elements of the care plan documented during the initial face-to-face visit including: basic demographic information, medication and allergy info, the patient’s consent to the service, and clinical summaries that can be shared with other physicians.

4) Set up a system that can keep track of time spent on non-face-to-face services provided, including:

  • Phone calls and email communication with patient.
  • Time spent coordinating care (by phone or other electronic communication) with other clinicians, facilities, community resources, and caregivers.
  • Time spent on prescription management and medication reconciliation.

5)   When billing for CCM make the date of service range the calendar month in which you are billing, for example – 01/01/2016-01/31/2016.

6)  A practice can insource or outsource the delivery of CCM services for its patients. In either case, your practice will need to establish a consistent system of documentation based on your own physical, staffing, and EHR configurations.

Once your tools and processes are set up, documentation of these services will go smoothly.

Print Post & Download PDF

What tips or tools have you implemented to make the most of your Chronic Care Management program?

 

 

is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

If You Liked This Post You Will Love These

6 Responses to Chronic Care Management: 6 Tips for Documentation Success

  1. My grandfather has MS and it is really hard for us to care for him sometimes. It does seem like it would be smart for my family to look into getting a professional medical service that does well with managing chronic illness to help him. It seems like that would be best for my family and my grandfather.

  2. Thank you so VERY much for putting together this work product and Blog. I and my staff follow and enjoy the Blod relating to Medicare Wellness. This is a welcome addition to our every day existence.

Leave a reply

Who Are We?

Capture Billing helps medical practices by reducing their insurance accounts receivable and getting claims paid faster, allowing doctors to focus on providing quality healthcare to their patients without the stress of doing their own medical billing.

That’s why we developed Capture Billing’s Rapid Revenue Recovery System to keep our clients’ Accounts Receivables down and their revenue flowing.

Learn More

Disclaimer

The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Learn how to outsource your Medical Billing today

CALL NOW  703-327-1800

Client Testimonials

Bob Laird

OBGYN COO

I would recommend Capture Billing to anyone who needs a billing company they can trust.

Bob Laird

Steve Rex

Family Practice

In a six month period Capture Billing increased our Practice’s income by over $100,000.

Steve Rex

Julie Reed-Humeniuk

Family Practice

Capture Billing goes over and beyond the call of duty for their clients to maximizing reimbursement.

Julie Reed-Humeniuk

CaptureBilling.com - Medical Billing Services

Capture Billing is a Medical Billing Company based in South Riding Virginia.

Join the other Doctors and Practice Managers that have benefited from our expert medical billing services.


Capture Billing & Consulting Inc.
25055 Riding Plaza #160
South Riding, VA 20152
Phone: (703) 327-1800

MENU