Chronic Care Management (CCM) helps patients manage their multiple chronic conditions and offers a valuable recurring revenue stream* for practices that serve CCM patients. The Centers for Medicare and Medicaid Services (CMS) provide reimbursements for these essential services, which include around-the-clock access to healthcare advice, monthly patient consultations, and logistical support for necessities like medication refills and transportation.
What is Chronic Care Management (CCM)?
The proactive, continuing care given to people with chronic illnesses including diabetes, heart disease, and COPD is referred to as chronic care management. Comprehensive care regimens, frequent check-ups, and efficient coordination between medical specialists are frequently necessary for many disorders. By creating a specialized care team, encouraging patient involvement, and utilizing technology to facilitate data management and communication, CCM seeks to maximize patient care.
How to Start the CCM Process?
To guarantee efficient care coordination and better patient outcomes, the chronic care management process entails a number of crucial elements. This is a summary of how the procedure usually operates:
- Identification of Eligible Patients
Patients with chronic illnesses who would benefit from chronic care management services are identified by healthcare practitioners. These individuals need continuous care and support because they frequently have several chronic diseases.
- Creating a Comprehensive Care Strategy
A thorough care plan customized to each patient’s need is developed by a committed care team made up of doctors, nurses, and other medical specialists. Goals, interventions, medication management, and patient education are all part of the plan.
- Regular Communication and Follow-Up
Whether in person or through telemedicine, the care team regularly checks in with patients to determine their current state of health, address any concerns, and offer any support that may be required. Phone calls and secure texting are two examples of communication channels that let patients and their care team stay in constant contact.
- Management of Medication
In addition to ensuring appropriate medication management, the care team keeps an eye on patients’ drug adherence and makes necessary prescription adjustments. This maximizes the efficacy of treatment and helps avoid negative drug interactions.
- Self-Management and Patient Education
In order to enable people to actively manage their chronic diseases, patient education is essential. To assist patients in understanding their diseases, changing their lifestyles, and following treatment regimens, the care team offers information, direction, and support.
Chronic Care Management CPT Codes
CPT 99487
Description: At least 60 total minutes of non-face-to-face consultation time over 30 days to create or oversee a care plan.
In order to account for the coordination of care given to patients that is particularly complicated, CPT 99487 was created in 2017. Medicare reimburses clinical personnel for the first 60 minutes of non-face-to-face care coordination when this code is used.
The lengthier 60 minutes of physician care time reimbursement and the necessity for intermediate or high-complexity medical decision-making for patients are the main distinctions between the requirements for CPT 99487 and CPT 99490, which was introduced earlier in 2015.
In order to be eligible for CPT 99487 reimbursement, further prerequisites and patient services must be met:
- It is anticipated that many chronic conditions will persist for at least a year or until the patient passes away.
- Chronic conditions that considerably increase the patient’s risk of acute exacerbation/decompensation, mortality, or functional decline.
- Creation or modification of an all-encompassing care plan.
CPT 99489
Description: CPT 99487 will be charged for each extra half-hour of consultation that does not take place in person.
For extra time spent on care coordination services each calendar month, CPT 99489 can be added to CPT 99487. CPT 99489 reimburses each extra half-hour spent on a session, while CPT 99487 reimburses the first sixty minutes of a consultation that does not take place in person.
Since patients with complex chronic care management frequently need multiple hours of non-face-to-face care coordination each month, this code was added in 2017.
CPT 99490
Description: At least 20 total minutes of non-face-to-face time spent tracking the treatment plan during a 30-day period.
CPT 99490 permits clinical staff to do non-face-to-face monitoring and non-complex CCM under a physician’s supervision and receive reimbursement. This code focuses on paying for services rendered to patients who have two or more chronic diseases in order to keep them from getting worse or escalating.
Except for a shorter minimum amount of care (20 minutes), the requirements to be eligible for CPT 99490 are the same as those for CPT 99487.
CPT 99439
Description: Clinical personnel provide care for the next thirty minutes.
When used in conjunction with CPT 99490, CPT 99439 allows for an extra 30 minutes of care for non-complex CCM to be given by clinical staff under a physician’s supervision each month.
CPT 99491
Description: A doctor or non-physician practitioner (NPP) personally provides the first half hour.
CPT 99491 was added in 2019 to reimburse physicians and nurse practitioners for at least 30 minutes of personal care. Similar patient qualifying requirements of two or more chronic illnesses, a substantial risk of death, acute aggravation, or functional deterioration, and the provision of comprehensive care are shared by this code and code 99490. The following distinguishes the two codes: CPT 99491 requires:
- Physicians and nurse practitioners must personally deliver CCM services.
- Thirty minutes or more of CCM care per month.
CPT 99437
Description: A doctor or NPP will individually provide care for the next thirty minutes.
For additional time beyond the first 30 minutes of care covered by 99491, use CPT 99437, an add-on code to CPT 99491.
CPT 99437 is subject to the same eligibility requirements and conditions as CPT 99490, 99439, and 99491. Like CPT 99491, CPT 99437 requires that all care be personally delivered by a physician, nurse practitioner, or other licensed healthcare provider in order to be eligible for reimbursement.
Top 5 Reasons of Outsourcing Medical Billing for OB/GYN Practices
The Benefits of Contracting Out Chronic Care Management
Healthcare organizations can gain a number of advantages by contracting with outside companies, such as RCM Matters, to handle their chronic care management needs. Healthcare companies may maximize their resources and concentrate on their core competencies by collaborating with us. The following are some benefits of outsourcing the management of chronic care:
- Expertise and Specialization
Registered nurses and other medical professionals with experience in managing chronic care are part of RCM Matters’ committed teams of specialists. Healthcare organizations may make the transition with little difficulty since they have the expertise and abilities needed to provide high-quality treatment and handle the intricacies of CCM.
- Cost Reduction
Healthcare firms may scale their CCM efforts according to patient volume and demand thanks to RCM Matters’ pay-per-service model and customizable service offerings.
By removing the need to recruit and educate new employees, outsourcing CCM services lowers overhead expenses. Adopting a new service eliminates the additional time and expense required for staff training as well as the costs related to a learning curve.
- Infrastructure and Technology
RCM is important because CCM teams use cutting-edge technologies to handle data, engage patients, and coordinate care effectively. Healthcare institutions can have access to these technology developments without having to incur large upfront costs by partnering with us.
- Regulatory and Compliance Proficiency
The dynamic healthcare environment necessitates compliance with a number of rules and regulations. The danger of fines and audits is decreased by outsourcing CCM services to outside service providers such as RCM Matters, which guarantees adherence to billing, documentation, and reporting regulations.
- Flexibility and Scalability
Scalable solutions are available from outside CCM service providers like RCM Matters to meet changing care requirements and patient load fluctuations. Depending on demand, healthcare companies can swiftly grow or shrink their CCM services, guaranteeing efficient use of resources.