Frequently Asked Questions

Do You Have Questions About Chronic Care Management?

Learn more about the revenue opportunities, requirements, and benefits of chronic care management (CCM) services below.

What are the potential financial benefits for providing CCM services?

Patients with two or more chronic diseases qualify for CCM services. For an individual physician with 200 patients who qualify, the original CCM CPT code 99490 can generate monthly revenue of $42 per patient per month for non-face-to-face care services. At 200 patients per month, this equates to monthly revenue of $8,400 and yearly revenue of $100,800. This additional revenue compensates providers for activities that are often already being performed by staff.

What do each of the various CCM codes mean? How much potential revenue can be earned from each?

In addition to the primary CPT code 99490, new codes were introduced in January 2017 which create new revenue opportunities for providers.

CPT code 99490 allows eligible care providers to bill for at least 20 minutes of non-face-to-face clinical staff time each month to coordinate care for patients with two or more chronic conditions.

• Revenue: $42/20 minutes

CPT code 99487 requires substantial revision of a care plan, moderate or high complexity medical decision making, and 60 minutes of clinical staff time.

• Revenue: $93/60 minutes

CPT code 99489 is a complex CCM add-on code to 99487 for each additional 30 minutes of clinical staff time.

• Revenue: $47/30 minutes

HCPCS code G0506 is an add-on code to the CCM initiating visit for providing a comprehensive assessment and care planning to patients.

• Revenue: $63/ one time

CPT Code 99358 is a prolonged E/M service provided by a physician before and/or after direct patient care.

• Revenue: $113/ 60 minutes

CPT code 99359 is an add-on code for prolonged E/M service provided by a physician before and/or after direct patient care (listed separately with 99358).

• Revenue: $55/ 30 minutes

Who is eligible to provide CCM services?

• Physicians

• Physicians assistants

• Nurse practitioners

• Clinical nurse specialists

• Certified nurse midwifes

What are the program requirements?

In January of 2017, CCM program requirements have been modified and simplified. Written consent from the patient is no longer a requirement; consent may be obtained verbally if the physician documents in the patient record that the required program information was discussed. To begin CCM services, the Initiating Visit is no longer mandatory as long as the patient is not a new patient and has been seen within the past twelve months. Program requirements that have remained the same in 2017 include twenty minutes of non-face-to-face clinical staff time per month and a care plan that must be made available to the patient and other health care providers.

Which Medicare patients are qualified to participate in this program?

Before beginning the CCM program, the first step is to see which of your Medicare patients are eligible to participate in this program. In order to qualify for CCM, Medicare patients must have two or more chronic conditions expected to last for twelve or more months that place them at risk for decompensation, functional decline, or death. On average, an individual primary care physician will have 200 patients who qualify and the Center for Primary Care (CPC) estimates that 75% of qualified patients will agree to participate in CCM.

Which chronic conditions are eligible for CCM services?

CMS does provide a specific list, but states that chronic conditions eligible for services include, but are not limited to:

• Alzheimer’s disease and related dementia

• Arthritis (osteoarthritis and rheumatoid)

•Asthma

• Atrial fibrillation

• Autism spectrum disorders

• Cancer

• Chronic obstructive pulmonary disease

• Depression

• Diabetes

• Heart failure

• Hypertension

• Osteoporosis

How is a care plan constructed? Is there a certain format that must be followed?

A care plan should be constructed to meet the specific needs of your patient. While there is no required format for care plan construction, there are typical components of a care plan. These components include a plan for coordination with other providers, a problem list, measurable treatment goals, symptom management, and a list of current medications and allergies. The typical components listed above may be documented through an annual wellness visit.

Are there specific technology requirements necessary to provide CCM?

There are no certified technology requirements necessary for CCM documentation, however a certified EHR is required for recording clinical information, which includes problems, medications, and medication allergies.

Are there any restrictions in billing for CCM services?

Yes, you will be unable to bill for the services listed below in the same month CCM is billed:

• Transitional care management (TCM) services (CPT 99495 and 99496)

• Home health supervision (HCPCS G0181)

• Hospice care supervision (HCPCS G0182)

• Certain end-stage renal disease (ESRD) services (CPT 90951-90970)

An exception to these billing restrictions applies to TCM, CPT 99495 and 99496. TCM and CCM may be billed in the same month if 20 minutes of CCM services has been provided between the time TCM concluded and the final day of the calendar month.

How much payment will beneficiaries be responsible for every month?

CMS’ intent is to minimize the amount of out-of-pocket expenses for patients; however, they will still be responsible for co-payments, deductibles, and remainder balances according to their insurance agreement. If your patient is a Medicare B patient with no secondary coverage, they will be responsible for paying a monthly fee of $8.

How will CCM be beneficial for my patients and practice?

Chronic care management (CCM) aims to improve care and outcomes for patients with chronic conditions, reduce the overall costs of patient care, and reduce avoidable hospital admissions.

What are the benefits associated with AviTracks-CM software?

Our cloud-based software, AviTracks-CM, enables you to maximize efficiency without adding overhead by automating your chronic care management workflow. Our flexible software supports your unique way of delivering care, while also adapting to the changing demands of the healthcare industry. AviTracks is designed to help you maximize your reimbursement from Medicare’s CCM program, improve patient outcomes, and reduce hospital admissions and ER visits.

How does AviTracks-CM software automate workflow?

AviTracks automates your entire care management workflow including enrolling the patient, creating patient-centered care plans, documenting medications, scheduling and tracking calls and other activities, and generating documentation needed for billing purposes.

What are AviTracks-CM’s security features?

AviTracks-CM is a HIPAA compliant web-based application that runs under encrypted technology, providing security for data in transit and at rest. Our IT infrastructure is audited annually for HIPAA, PCI, SSAE-16, SOC 1, SOC 2, and Safe Harbor compliance to ensure the integrity of our software.

Additional security features include:

• Nationally Recognized Cloud Provider

• Five fully redundant data centers in the geographically safe Midwest region

• Full Chain of Business Associate Agreements (Customer, Avicenna, Cloud)

• Comprehensive suite of security technologies

• Antivirus protection

Is there an upfront fee to begin using AviTracks-CM?

No, there is no large upfront investment to begin using AviTracks-CM. Instead, we offer an affordable monthly subscription based on the number of patients you have enrolled in your CCM program.

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