OVER $200,000 PER YEAR NOW
AVAILABLE FOR MEDICARE CHRONIC
CARE MANAGEMENT SERVICES
Beginning this year, CMS will provide reimbursement to physicians
and other health care providers for chronic care management for
Medicare recipients with multiple conditions, delivered outside
regular office visits. This change now recognizes the additional
administrative burden that comes with managing patients with
multiple conditions.
CMS will reimburse $40.39 for chronic care managem ent CPT code
99490. This code can be billed up to once a month per qualified
patient. Since Medicare Advantage plans must provide services that
traditional Medicare covers, this code will also be reimbursable,
presumably paid for in the same manner as it now pays for other
physician services.
There are five capabilities that CMS requires a provider to fulfill before being able to bill for this new Chronic Care Management code:
Once a provider meets these capabilities, they must follow the steps
below in order to meet the requirements for reimbursement:
yy
Identify Medicare patients with at least two chronic conditions,
who are expected to live at least 12 months
yy
Notify the patient that you will be providing chronic care management services and obtain written consent, informing the
patient of their rights
yy
Provide 20 minutes or more of non-face-to-face chronic care
management services once per calendar month
For more information on the requirements for billing Chronic Care
Management services, please contact the GLMS Physician Education
& Practice Support Department at [email protected]
or 502-736-6354.
(1) Use a certified EHR for specified purposes; (2) Maintain an electronic care plan; (3) Ensure beneficiary access to care; (4) Facilitate
transitions of care; and (5) Coordinate care.
POTENTIAL CCM GROSS ANNUAL REVENUE
DESCRIPTION
AVERAGE
FORMULA
Annual Number of Unique
Patients1
3279
A
Percent of Patients
Covered by Medicare1
21.85%
B
Annual Number of Unique
Medicare Patients
716
C = A*B, Rounded
Percent with 2+ Chronic
Conditions2
68.60%
D
Annual Number of Unique
CCM Patients
491
E = D*C, Rounded
CCM Monthly Payment
$40.39
F
Estimated Annual Gross
Revenue for Family
Medicine Physicians
$237,978
G = (F*12)*E
3
Per the MGMA Cost Survey for Single Specialty Practices: 2013 Report Based
on 2012 Data specific to the specialty of family medicine. Includes Medicare A/B
and Medicare Advantage.
1
CMS.gov - County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average
2
3
Reimbursement amount from the CY 2015 Physician Fee Service Final Rule;
6
Offering extensive evaluations for food,
inhalant, pet, and skin allergic illnesses.
Focusing on a systematic approach to food
intolerances with emphasis on gluten,
bladder, and bowel disorders.
C. Steven Smith, M.D, M.S., FAAAAI
Board Certified in Allergy, Asthma, Immunology, &
Pediatrics
1009B Dupont Square North
Louisville, KY 40207
502.895.3330
[email protected]
www.drsmithallergy.com
GLMS NEWS JANUARY 2015