CHRONIC CARE MANAGEMENT - PowerPoint Presentation

1. CHRONIC CARE MANAGEMENT Presentation for Health Care Professionals

2. CHRONIC DISEASE BURDEN IN THE UNITED STATES6 in 10 American adults have a chronic condition (117 million people)140% of Americans have 2+ chronic conditions18 of the top 10 causes of death in 2021 were from chronic diseases2People with chronic conditions account for 90% of all health care spending3Individuals from racial and ethnic minorities receive poorer care than White individuals on 40% of quality measures, including chronic care coordination and patient-centered care4

3. CMS AND CHRONIC CAREMedicare benefit payments totaled $829 billion in 20215Two-thirds of Medicare enrollees have 2+ chronic conditions6Over 90% of Medicare spending is on patients with chronic conditions7Annual per capita Medicare spending increases with enrollees' number of chronic conditions3 

4. WHAT IS CHRONIC CARE MANAGEMENT (CCM)?CCM is care coordination outside of a regular office visit for patients with 2+ chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. It provides access to care outside of and in between doctors’ visits.CCM services can also help reduce geographic and racial or ethnic health care disparities.

5. WHAT IS CCM? (CONTINUED)Ongoing CMS effort to pay more accurately for CCM in “traditional” Medicare by identifying gaps in Medicare Part B coding and payment (especially the Medicare Physician Fee Schedule or PFS)Initially adopted CPT code 99490 beginning January 1, 2015 to separately identify and value clinical staff time and other resources used in providing CCM Beginning January 1, 2017, CMS adopted 3 additional billing codes (G0506, CPT 99487, CPT 99489) Beginning 2022, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill Chronic Care Management (CCM) and Transitional Care Management (TCM) services for the same patient during the same time period Detailed guidance on CCM and related care management services for physicians available on the PFS web page at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management.html 

6. ELEMENTS OF CCM SERVICESStructured recording of patient health information Keeping comprehensive electronic care plans Managing care transitions and other care management services Coordinating and sharing patient health information promptly within and outside the practice 

7. WHO CAN BILL FOR CCM SERVICES?Physicians and certain Non-Physician Practitioners (Physician Assistants, Certified Nurse Midwives, Clinical Nurse Specialists, Nurse Practitioners) Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Hospitals, including Critical Access Hospitals 

8. WHAT ARE THE BENEFITS OF CCM?FOR YOUR PATIENTSFOR YOUR PRACTICETeam of dedicated health care professionals to plan for better health and stay on track for good healthComprehensive care plan to support disease control and health management goals, including outside resources, community support, referrals, and educational informationAdditional support between visits and more frequent communication with providersImproved care coordination and health outcomesIncreased patient satisfaction, compliance, efficiency, and connectionDecreased hospitalization and emergency department visitsAbility to sustain and grow your practice, including additional resources to care for high-risk, high-needs patientsReduced operational costs and additional payment

9. CCM CODING SUMMARYBILLING CODEPAYMENT (PFS NON-FACILITY)CLINICAL STAFF TIMECARE PLANNINGBILLING PRACTITIONER WORKNon-Complex CCM (CPT 99490)$4320 minutes or more of clinical staff time in qualifying servicesEstablished, implemented, revised, or monitored Ongoing oversight, direction, and managementComplex CCM (CPT 99487)$9460 minutesEstablished or substantially revised Ongoing oversight, direction, and management + Medical decision-making of moderate-high complexityComplex CCM Add-On (CPT 99489, use with 99487)$4720 minutes or more of clinical staff time in qualifying servicesEstablished or substantially revised Ongoing oversight, direction, and management + Medical decision-making of moderate-high complexityCCM Initiating Visit (AWV, IPPE, TCM, or Other Face-to-Face E/M)$44-$209--  -- Usual face-to-face work required by the billed initiating visit codeAdd-On to CCM Initiating Visit (G0506)$64N/AEstablishedPersonally performs extensive assessment and CCM care planning beyond the usual effort described by the separately billable CCM initiating visit

10. REFERENCESAbout Chronic Diseases. National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/chronicdisease/about/index.htm Leading Causes of Death. National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm Reddy A, Marcotte LM, Zhou L, Fihn SD, Liao JM. Use of Chronic Care Management Among Primary Care Clinicians. Ann Fam Med. 2020 Sep;18(5):455-457. doi: 10.1370/afm.2573. 2019 National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Dec. DISPARITIES IN HEALTHCAREWhat to Know about Medicare Spending and Financing. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-spending-and-financing/ Lochner KA, Cox CS. Prevalence of multiple chronic conditions among Medicare beneficiaries, United States, 2010. Prev Chronic Dis. 2013 Apr 25;10:E61. doi: 10.5888/pcd10.120137.The Medicare Learning Network. Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNGenInfo