Fueled by a growing aging population, sedentary lifestyles, changing diets, and increasing obesity levels, chronic diseases are on the rise.1
In fact, it will probably come as no surprise to you that 75% of typical primary care visits are for multiple chronic illnesses.2 A staggering 1 in 4 Americans have multiple chronic conditions. This number jumps to 3 in 4 for Americans over the age of 65.3
A patient population that needs more from you
For you, this means managing a greater number of older patients with significant healthcare challenges—a group that requires not only additional care coordination, but also more time than you may be prepared to give. In the U.S., 24% of primary care doctors say their practices are not equipped to manage care for patients with multiple chronic conditions.4
The good news? Today, there is a solution that can help you manage your patients with chronic conditions. And the Centers for Medicare & Medicaid Services (CMS) pays physicians for addressing the needs of these Medicare patients.
Here’s what you need to know.
Chronic care management reimbursed by CMS
CMS now pays physicians approximately $43 per patient per month (for an exact amount, please refer to your Medicare administrative contractor) for providing chronic care management (CCM) for Medicare patients with 2 or more chronic conditions.5
Under the CMS 2017 Medicare Physician Fee Schedule Final Rule, to bill for CCM under CPT code 99490*, clinical staff under the general supervision of a physician must provide a minimum of 20 minutes of non-face-to-face care management services per patient per month. Complex cases, billed under CPT code 99487*, require a minimum of 60 minutes, as well as a revised care plan.
Implementing CCM in your practice
Thirty-nine percent of patients with chronic conditions indicate that they are likely to need help managing their conditions between appointments.6 You can help them—and help improve adherence, testing follow-through, and health outcomes—by providing patient-specific support beyond the office setting.
A practice can insource or outsource the delivery of CCM services. CMS outlines requirements for CCM services, including details regarding billing requirements, patient consent, and documentation.
Whether you choose to implement services yourself or outsource them, the process involves the following steps:
- Identify and recruit eligible patients—use your EHR to identify your Medicare patients with 2 or more chronic conditions expected to last at least 12 months or until death, then contact those patients or discuss CCM services during their next visit
- Educate and enroll patients—explain how CCM services work, the value of those services, and patient cost (roughly $8 per month if not covered by secondary insurance7), then obtain the patient’s verbal or written consent to participate
- Engage patients in the program—develop patient-specific care plans, share them with patients and other clinicians, and provide and document non-face-to-face services, including patient calls and email communication
- Bill for reimbursement—confirm that the requirements are met for each patient each month, and submit CCM billing under the appropriate CPT code
A capable, caring, and responsible partner in chronic care
Quest Diagnostics now offers services that can help you extend care beyond your office setting to effectively manage Medicare patients with multiple chronic conditions.
Quest Chronic Care Management (CCM) Services are designed to help you minimize disruptions, save staff time, comply with CMS reimbursement requirements, and improve health outcomes.
With Quest CCM Services, your practice benefits from:
- Expertise to extend care beyond your office
- Tools to help you meet CCM care goals and comply with CMS reimbursement requirements
- A comprehensive program that handles administrative tasks
By implementing chronic care management services in your practice, you’ll provide extra support for the patients who need it most—helping to enhance patient engagement and adherence, boost practice economics, and improve health outcomes.
*The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
1.Deloitte. 2017 global health care outlook: Making progress against persistent challenges. 2017.
2. Zamosky L. Chronic disease: A growing challenge for PCPs. Medical Economics. Available at medicaleconomics.modernmedicine.com/medical-economics/content/tags/chronic-disease/chronic-disease-growing-challenge-pcps. Accessed July 13, 2017.
3. Centers for Disease Control and Prevention. Multiple chronic conditions. Available at cdc.gov/chronicdisease/about/multiple-chronic.htm. Accessed July 13, 2017.
4. The Commonwealth Fund. Primary care physicians in ten countries report challenges caring for patients with complex health needs. Available at commonwealthfund.org/publications/in-the-literature/2015/dec/primary-care-physicians-in-ten-countries. Accessed July 13, 2017.
5. Centers for Medicare & Medicaid Services. Chronic care management services changes for 2017. Available at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Chronic-Care-Management-Services-Changes-2017-Text-Only.pdf. Accessed August 14, 2017.
6. West. Strengthening chronic care: patient engagement strategies for better management of chronic conditions. 2017.
7. American Academy of Family Physicians. Frequently asked questions: Medicare’s chronic care management (CCM) services. Available at www.aafp.org/fpm/2015/0100/fpm20150100p7-rt4.pdf. Accessed August 14, 2017.