Presentation on theme: "Getting Paid for Chronic Care Management under Medicare in 2015"— Presentation transcript:
1 Getting Paid for Chronic Care Management under Medicare in 2015 Kent J. MooreSenior Strategist for Physician PaymentJanuary 27, 201512:30 p.m. (CST)
2 What We Hope to Do Today Identify eligible types of Medicare patients Summarize the scope of CCM services expected by MedicareClarify what is needed to get Medicare patient agreement before providing and billing CCM servicesClarify how to document, code, and bill Medicare for CCM servicesProvide resources and answer questions
4 Who’s eligible?Patients with multiple (two or more) chronic conditionsConditions are expected to last at least 12 months, or until the death of the patientConditions 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 weekContinuity of careCare management for chronic conditionsCreation 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 settingsCoordination with home- and community-based clinical service providersEnhanced opportunities for a patient and any relevant caregiver to communicate with the provider regarding the beneficiary’s careElectronic 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 servicesOf the right to stop CCM services at any time (effective at the end of the calendar month)Of the effect of revoking their agreementThat 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 monthBill using CPT® code 99490Bill at the end of the monthCollect any deductible or coinsurance from the patientRemember the exceptions
10 AAFP ResourcesFamily Practice Management article -“Getting Paid” blog -Practice Management Help Desk –Staff – Kent Moore and Barbie Hays