The fundamental goal of chronic care management is to aid patients with better and quality care and management. The Centers for Medicare and Medicaid have recognized chronic care management as crucial component that contributes to good patient responsibility. Few years back Medicare started paying separately for chronic care management under Medicare Physician Fee Schedule.

It’s not surprising to know implementing chronic care management involves few steps to follow. They are:  identifying patients, educating and enrolling patients, engaging with patients, maintaining documentation, and billing for reimbursement. But there are few questions to be answered.

  1. What’s the difference between Chronic care management and complex chronic care management services?
  • Complex chronic care management services come under the criteria of chronic care management with an additional requirement of establishment of a comprehensive care plan, medical decision-making of moderate to high complexity, and at least 60 minutes of clinical staff time.
  1. Can all physicians and specialists bill CCM services, or it’s only for primary care healthcare professionals?
  • Of course, any healthcare professional who encounters the reporting requirements can readily bill for CCM.
  • Physicians or specialists, who are treating patients with at least two or more chronic conditions, could also be eligible to bill the codes. Only one physician per month may need to report these services.
  1. Are there certain diagnoses for only which the CCM code can be reported?
  • No defined lists of diagnoses codes are mentioned to meet the requirements.
  • The required list includes the chronic conditions place, the patient at significant risk of death, acute exacerbation or de-compensation, functional decline along with a care plan.
  • Patients with two or more of the following conditions may be appropriate for the use of chronic care management services:
  1. Neurocognitive disorders including Alzheimer’s disease, Dementia, and Parkinson’s disease.
  2. Stroke with late effects that place the patient at risk for falls, fractures, and aspiration pneumonia.
  3. Poorly controlled diabetes mellitus.
  1. Can Advance Practice Providers bill for CCM services?
  • Advance Practice Providers with a unique tax pay ID can separately report the services allows incident to billing.
  • Advance Practice Providers’ time under the supervision of a healthcare professional can be counted with the total time used to report a CCM code.
  1. Should the Neurologists manage all of the chronic conditions of the patient in order to utilize the CCM code?
  • It’s evident that Neurologists has to manage all of the patient’s chronic conditions to report chronic care management. Of note, only one physician or specialist or healthcare provider is allowed to bill and pay for the services during any one calendar month.
  1. Can an E/M visit be billed at the same time as the CCM code?
  • In fact, any clinical staff time on a day, when the healthcare professional reports an Evaluation and Management service, may or may not be counted toward the care management service code.
  • Evaluation and Management services may be reported separately by the same physician during the same calendar month.

  1. Will these patients need to provide copay while reporting CCM services?
  • These patients indicate to the healthcare professionals that they require chronic care management services.
  • It is the responsibility of the healthcare provider to understand and notify the patient of the co-insurance or copay along with document patient consent in the medical record.
  1. Can Chronic Care Management services be reported if the patient or caregiver has not given consent?
  • One of the main requirements for billing CCM services is “knowledge and recognition by the patient that the physician will perform care management services on the patient’s behalf.”
  • In the event of an audit, documentation of patient consent in the patient record is very essential and crucial.
  1. Is a new consent form necessary for each month when the service is provided?
  • With the absence of Medicare guidance, it’s believed, a reasonable assumption is that the consent would apply for the period of time established for the care plan.
  1. Can all of the required elements be met in order to report CCM services?
  • Yes, all of the required elements as listed in the CPT guide should meet in order to report the service.
  1. Can Chronic Care Managements services be reported when the total time spent on care management for a patient is less than 20 minutes in a month?
  • Nope! Only one requirement of CPT code is at least 20 minutes of clinical staff time directed by a physician or specialist time, if the physician performs the clinical staff function.
  • This language actually deviates from previous CPT standards around time-based coding, that allows a service to be reported once the mid-point is reached.
  1. Can Chronic care management time within the emergency department be reported using codes?
  • Time within the emergency department can be reported, but the time when the patient is inpatient or admitted as observation can’t be reported using codes.
  1. What date of service should be used when reporting CCM services?
  • Medicare is yet to specify the date of services to bill as they did with the Transitional Care Management services.
  • Usually, when the code elements meet the provider, they should choose that date as the date of service.
  • No reason seems to hold the claim unless CMS or third party payers provide further guidance.
  • Consecutive month billing need not necessarily be 30 more days apart, only if the months differ.
  1. Can other care management services be reported in addition to the CCM?
  • Not really. Additional care management services cannot be reported separately during the month for which chronic care management services are reported.
  • It includes care plan oversight services, prolonged services without patient contact, anticoagulant management, medical team conferences, education and training, telephone services, online medical evaluation, preparation of special reports, analysis of data, transitional care management services, and medication therapy management services.
  • These services might have higher payments than Chronic Care Management in few cases.

 

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