Q1: What is the Chronic Care Management program?
The CCM program is a Medicare reimbursement opportunity for physicians who provide at least 20 minutes of non-face-to-face care coordination and care plan management services to Medicare patients with two or more chronic conditions that place the patient at significant risk.
Q2: What chronic conditions are eligible for this program?
Chronic conditions that are eligible for this program include, but are not limited to:
- Alzheimer’s disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Atrial fibrillation
- Autism spectrum disorders
- Chronic obstructive pulmonary disease
- Heart failure
- Ischemic heart disease
Q3: What services are required and covered in this program?
Each month, the physician and/or clinical staff member must provide at least 20 minutes of non-face-to-face care coordination and care plan management services. These services include:
- Recording a patient’s demographics, conditions, medications, problems, and allergies to create a clinical summary record that is housed in a certified EMR.
- Creating a care plan that focuses on the patient’s two or more chronic conditions, but is a comprehensive plan of care for all health issues. This plan must be made available to the patient, and electronically with practitioners outside the practice as appropriate.
- Providing 24/7 access to care management services
- Ensuring continuity of care with other practitioners as needed
Q4: Who can provide CCM services?
The Centers for Medicare and Medicaid (CMS) requires that a clinical staff member provide the services. A clinical staff member is considered someone who is under the supervision of a physician or other qualified health care professional who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. CMS defines the eligible non-physician practitioners as:
- Certified Nurse Midwives
- Clinical Nurse Specialists
- Nurse Practitioners
- Physician Assistants
Q5: How many of my Medicare patients are eligible?
Medicare estimates that 2/3 of Medicare beneficiaries have 2 or more chronic conditions, making them eligible to enroll in the program.
Q6: How do I enroll a patient in the CCM program?
The following steps are required to enroll new patients:
- Educate the patient on the CCM program by providing a high-level program description
- Explain the manner in which the CCM services will be provided
- Notify the patient of their right to stop at any time (sample termination form)
- Inform the patient that only one practitioner can provide these services during a calendar month
- Explain that their health information might be shared with other practitioners only when necessary and appropriate
- Notify the patient that they will be responsible for any associated coinsurance or deductibles
- Obtain the beneficiary’s consent and signature on an agreement form (sample consent template)
- Create the initial care plan for the patient and house in the EMR
- Send out welcome letter and first visit checklist (sample welcome letter template)
Q7: What documentation does CMS require?
CMS requires the following documentation:
Q8: Do I have to use an EMR for these documentations and services?
Yes. CMS requires the use of a version of a certified EHR that is acceptable under the EHR Incentive Programs as of December 31st of the calendar year preceding each Medicare PFS payment year. For more information, visit http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms. A comprehensive list of EMR requirements for the CCM program is available HERE.
Q9: What CPT codes do I bill for CCM? How much is this code worth?
Q10: Who can bill for CCM services?
While any physician (primary care or specialist) can bill for the CCM services, only one practitioner may be paid for the CCM service for a given calendar month. CMS will pay the first claim that it receives.
Q11: Are there any billing restrictions for the CCM CPT codes?
Yes. The following codes cannot be billed during the same month as CCM (CPT 99490) for the same patient:
- Transitional Care Management (TCM) (CPT 99495, 99496)
- Home healthcare supervision (HCPCS G0181)
- Hospice care supervision (HCPCS G9182)
- Certain ESRD services (CPT 90951-90970)
Q12: How will NYMP support me in delivering CCM services?
NYMP is prioritizing development of an infrastructure to support physicians in the CCM program, including practice training, EMR and technical support, as well as dedicated care managers for patient outreach. NYMP will be introducing a number of initiatives over the coming months to further support NYMP providers in participating in CCM and ensure they are receiving additional revenue from the program. For more information, please contact Joanne Newcombe at firstname.lastname@example.org.
1 CMS 2016 Physician Fee Schedule