1. Getting Paid for Chronic Care Management under Medicare in 2015
Kent J. Moore
Senior Strategist for Physician Payment
January 27, 2015
12:30 p.m. (CST)

2. What We Hope to Do Today Identify eligible types of Medicare patients
Summarize the scope of CCM services expected by Medicare
Clarify what is needed to get Medicare patient agreement before providing and billing CCM services
Clarify how to document, code, and bill Medicare for CCM services
Provide resources and answer questions

3. Polling Question

4. Who’s eligible?
Patients with multiple (two or more) chronic conditions
Conditions are expected to last at least 12 months, or until the death of the patient
Conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

5. What are the scope of CCM services?
Access to care management services 24 hours a day, 7 days a week
Continuity of care
Care management for chronic conditions
Creation of a patient-centered care plan document to ensure that care is provided in a way that is congruent with patient choices and values

6. What are the scope of CCM services? (cont’d)
Management of care transitions between and among health care providers and settings
Coordination with home- and community-based clinical service providers
Enhanced opportunities for a patient and any relevant caregiver to communicate with the provider regarding the beneficiary’s care
Electronic capture and sharing of care plan information

7. What is needed in terms of patient agreement?
You must inform the patient:
Of the availability of CCM services
Of the right to stop CCM services at any time (effective at the end of the calendar month)
Of the effect of revoking their agreement
That Medicare will pay only one provider for these services during a calendar month

8. What is needed in terms of patient agreement? (cont’d)
You must:
obtain a patient’s written agreement to provide the services (including authorization for the electronic communication of his or her medical information with other treating providers)
document in the patient’s medical record that you explained and offered all of the CCM services to the patient and note the patient’s decision to accept or decline these services.

9. How do I get paid?
Document at least 20 minutes of clinical staff time for the calendar month
Bill using CPT® code 99490
Bill at the end of the month
Collect any deductible or coinsurance from the patient
Remember the exceptions

10. AAFP Resources
Family Practice Management article -
“Getting Paid” blog -
Practice Management Help Desk –
Staff – Kent Moore and Barbie Hays