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Chronic Care Management Services
Medicare is rewarding new processes aimed at improving patient care and reducing healthcare expenses. One new program that became eligible for physician reimbursement is a program intended to monitor certain patients with multiple chronic conditions.
As of January 1, 2015, Medicare is paying for a non-face-to-face care coordination service through use of billing code 99490. The Chronic Care Management Services may be provided by phone or tele-health by a qualified health care professional under the physician’s general supervision.
The service is usually offered as a 20 minute contact once every calendar month.
An estimation provided by this CCM calculator shows that just 50 enrolled patients could equate to an additional $25,560 in revenue for the practice each year.
This is a relatively new program that an entrepreneurial pharmacist could easily implement for multiple physician groups in their area for a fee.
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
CMS requires the billing practitioner to furnish one of the following.
Prior to billing the CCM service, and to initiate the CCM service as part Patient Agreement of this visit/exam.
12 Components of CCM
The two key differentiators between 99487 and 99490 are the additional time (60 minutes for CPT 99487 from 20 minutes for CPT 99490) and the requirement around medical decision making. In addition, a code reimbursing for additional time (CPT 99489) is available for complex CCM patients being billed under CPT 99487.
Provider can bill for G0506 in addition to the AWV/IPPE billing
Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services (billed separately from monthly care management services and MAY BE ADDED TO AN AWV- but must be seen by a QHCP)
The G0506 code is particularly appropriate when the CCM initiating visit is a less complex visit (such as a level 2 or 3 E/M visit). G0506 can be billed along with higher level E&M visits if the practitioner’s effort and time exceeded the usual effort described in the initial visit E&M code. G0506 can also be billed when the initiating E&M visit addresses problems unrelated to Chronic Care Management and the CCM related work is not included in the initial visit code.
Could be face-to-face and/or non-face-to-face, but the time spent doing the CCM care planning must not already be reflected in the CCM initiating visit itself or in the time spent during the monthly CCM (i.e., in CPT 99490, CPT 99487, CPT 99489)
G0506 is meant to be billed only once per beneficiary during the initiation of the patient into Chronic Care Management.
What do are your thoughts? Would this be a viable business model in your area? Leave a comment below.
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ABOUT THE AUTHOR:
Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and two children. Her latest project is the host and producer of pharmacy’s first virtual conference, the Elevate Pharmacy Virtual Summit in partnership with the NCPA Innovation Center. She is the founder of Pharmapreneur Academy, an online e-Course and Community where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and facilitates in-person Business Planning Workshops and Mastermind Retreats for female Pharmapreneurs across the country. More information about Dr. Thielemier can be found on her website.
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