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Benefits of Chronic Care Management

Updated: May 7

How Does Chronic Care Management Work?

 

Chronic Care Management (CCM) involves the coordination of health services for patients with two or more chronic conditions expected to endure for at least a year or until their demise. These conditions must pose a significant risk of death, acute exacerbation, or functional decline. Recognized by the Centers for Medicare & Medicaid Services (CMS), CCM services are provided outside of regular office visits.

 

Since 2015, CMS has allowed providers to seek reimbursement for CCM services rendered to patients. Reimbursement is feasible when at least 20 minutes of non-face-to-face clinical staff time, under the guidance of a physician or qualified healthcare professional, is dedicated to patient care within a calendar month. This time is devoted to managing and coordinating care for eligible Medicare and dual-eligible beneficiaries.

 

Approximately one in four adults, including 70% of Medicare beneficiaries, have two or more chronic conditions, rendering them eligible for CCM services. This underscores the vast opportunity for providers to enhance both patient health outcomes and the efficiency of their practice.

 

Benefits of Chronic Care Management

 

CCM offers numerous benefits for both providers and patients.

 

For physicians, implementing a CCM program enhances the quality of care provided to patients. It facilitates routine monitoring of patients' health, supplying monthly insights that can inform adjustments to care plans and medications. Studies indicate that CCM reduces office visits as patients become adept at managing their health, thus optimizing practice efficiency and bolstering the reputation of the healthcare provider and their practice.

 

For patients, CCM provides round-the-clock access to a dedicated team of healthcare professionals committed to improving and sustaining their health. Patients receive personalized care plans addressing various aspects of their well-being, including physical, mental, and social dimensions. Regular care through CCM reduces the need for office and emergency room visits, saving patients time and money. Moreover, the personalized attention fosters a sense of importance, strengthening the provider-patient relationship and encouraging patients to play a more active role in managing their health.

 

CMS Reimbursement

 

CMS reimburses providers for delivering CCM services, offering an additional revenue stream for practices. Providers can bill for a minimum of 20 minutes of CCM per patient per month.

 

CCM Coding and Billing Requirements

 

Understanding CMS coding and billing requirements is crucial for implementing a successful CCM program. CMS distinguishes between complex and non-complex care for CCM, with differences in clinical staff service time, practitioner involvement, and extent of care planning.

 

For non-complex care, CMS introduced a new code (99439) in 2020 to account for additional 20-minute increments of clinical staff time per month, alongside the initial 20 minutes (99490). This allows practices to bill for up to 60 minutes of total staff time.

 

For complex care, the billing structure remains unchanged from 2019. Practices can bill for 60 minutes of complex care (99487) and additional 30-minute increments (99489) without a cap on total minutes billed.

 

Utilizing software solutions can streamline billing processes and ensure accurate coding, maximizing reimbursement for CCM services provided by the practice.


Offer Chronic Care Management To Your Patients With ChronicCare


ChronicCare partners with Physicians, Hospitals, Payors, and Employers to offer Chronic Care Management Services to their patients. We are dedicated to helping people improve their health and quality of life by maximizing their healthcare outcomes. We bridge the gap between healthcare visits, in order to ensure patients are continually cared for each month. 


Click here to connect with our team, we'd love to discuss potential benefits to your patients, staff, and practice.

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