chronic care management

In the United States, there are currently one in three adults suffers from at least one chronic illness. Whereas, one in four adults suffers from two or more chronic conditions. With ineffective management, these statistics are likely to worsen and may even increase to four or more chronic illnesses per person, depending on their health. In light of the increasing exposure to risk factors, the immediate persisting problem of chronic conditions will only become more prevalent if proper healthcare management is not set up.

The risk factors of general chronic conditions, such as COPD include, but are not limited to, tobacco use, lack of physical activity in recent generations, and medical advances that tend to minimize mortality without improving the patient’s health condition. In 2005, the Chronic Care Management Healthcare system was initiated to deal with these pressing issues and provide optimal healthcare services along with safer living conditions. Let us have a look at what chronic care management is.

What is Chronic Care Management in Healthcare?

Chronic care management involved the means to ensure better health and care for individuals. This includes timely reimbursement of the services provided by healthcare professionals. Chronic care management or CCM services in healthcare apply to patients with two or more chronic conditions, putting them at a greater risk of functional decline, exacerbation, or even death.

After reaching a diagnosis for the provision of chronic care management, the clinic or hospital staff is required to go over the extensive electronic health record of their patients to facilitate optimum care. This may include the patient’s current conditions, allergies, medical history, past care providers, and medications prescribed. The increased efficiency in the healthcare system owing to CCM services aid in reducing overall health costs.

What is a CCM-eligible Chronic Condition?

According to the chronic care management guidelines 2020 issued by the Centers for Medicare and Medicaid Services (CMS), your condition can only qualify the eligibility criteria if your condition is chronic, that is, expected to last at least 12 months, or until the death of the patient. Out of the many medical conditions that qualify for chronic care management services, here are a few of the most common ones:

  • Multiple sclerosis
  • Lupus
  • HIV/AIDS
  • Hypertension
  • Heart disease
  • Diabetes
  • Depression
  • Dementia
  • Cardiovascular disease
  • Cancer
  • Autism
  • Asthma
  • Arthritis
  • Alzheimer’s disease

Who Can Bill For CCM Services?

The billing of chronic care management services plays an extremely critical role in the efficiency of the healthcare system at a medical facility. It is important that the CCM billing is restricted to certain personnel to ensure quality services. Critical Access Hospitals or CAHs, Rural Health Clinics or RHCs, and Federally Qualified Health Centers or FQHCs can offer CCM amongst healthcare facilities. The billing procedure of CCM services is restricted to the following personnel.

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physicians- generally primary care
  • Physician Assistants
  • Non-Physician providers (NPPs).

Chronic care management service billing only applies in cases where the healthcare provider has had an in-person visit, obtained written or verbal consent from the patient, and constructed a comprehensive care plan in the hospital’s EHR or electronic health record.

How do identify patients that would benefit from Chronic Care Management?

Once you have learned what chronic care management is, you may be wondering where to put it to use. It is best to find patients that benefit from your CCM services to ensure efficient and quality care provision at your healthcare facility. While identifying patients who are eligible to receive CCM services is a quite daunting process, it does make things easier in the future.

There is no specific way to decide which of your patients are eligible to receive billing under chronic care management services and which are not. The eligibility criteria need to be tailored according to the practices carried out at your practice. Some practices may be using their electronic health records to decide which patient qualifies for CCM, while others may use an AWV (Annual Wellness Visit) or IPPE (Initial Preventive Physical Exam).

Billing Codes for Chronic Care Management

The service period per every chronic care management is one month. As a practitioner, you are required to submit your claim at the end of each service period or after you have completed the minimum required service time. After ensuring that your patient qualifies for CCM services, establishing a comprehensive care plan, and receiving explicit consent, you may forward their service claims for reimbursements.

The only way to file a claim is via CPT codes. There is a separate CPT code for each service to maintain transparency and efficiency and minimize room for errors. The following CPT codes are the ones most commonly associated with chronic care management.

  • CPT 99490 codes for the first 20 minutes of non-complex chronic care management per the one-month service time. These services code for the time spent treating the patient by the clinical staff as directed by the physician or any other healthcare professional.
  • CPT 99491 codes for non-complex chronic care management services that extend to a total of at least 30 minutes per one-month service time. Services coded under this CPT are required to be provided in person by a physician or any other qualified healthcare professional.
  • CPT 99439 codes for additional care that exceeds the 20 to 30-minute time allotment. For every additional 20-minute non-complex CCM addition to the total time, healthcare systems use HCPCS G2058. It can be used up to three times, making a total of 60-minute additional time.
  • CPT 99487 codes for complex chronic care management services that amount to up to 60 minutes of total clinical staff time per one-month service time. The services offered under this code work significantly to revise or install a comprehensive care plan via a range of moderate to highly complex decision-making.
  • CPT 99489 codes for an additional 30-minute time increment of complex chronic care management provided to the patient per the one-month service time.

Why Should You Provide CCM To Your Patient?

The process of chronic care management does not just benefit the provider. Instead, its benefits extend to the patient and reduce room for billing errors. Timely billing and reimbursements using the CCM services allow your clinic or hospital staff to focus better on their job. This means that the patients will receive a better, more focused, carefully coordinated, and highly equipped team of healthcare professionals that will work simultaneously to cater to their health problems.

The implementation of comprehensive care plans tailored specifically to cater to the patient’s needs help in maintaining better track progress of the patient’s health goals. While timely reimbursements seem like the greatest advantage of resorting to CCM services, they improve your practice efficiency, and hence, patient satisfaction and compliance.

See Also: What To Know About Medical Billing Errors And Patient Rights

Conclusion

Shortly, we may see dynamic growth in tech-enabled Chronic Care Management Healthcare companies. The partnerships between such outsourced CCM service providers and physicians/health practitioners will aid in increasing the effectiveness of the revenue stream system in healthcare.

We understand that comprehending the key concepts of working in a chronic care management system can be a lot. With Precision Hub, streamline your claims management process in the best way possible and you will never have to worry about errors in your CCM services again!

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