What You Should Know About the New Chronic Care Management Code

By Kathy McCoy, HealthFusion

As you may have heard, there is some good reimbursement news for primary care physicians in 2015: CMS has announced a new chronic care management program that went into effect on January 1 that will allow you to bill for providing care management for your patients with chronic conditions.

In other words, you can get paid for doing things you likely already do.

With this new code, chronic care management can provide a good source of revenue for your practice, if designed, managed and billed correctly. Since a provider can bill $41.92 per patient per month, if you have a number of patients with chronic conditions, you could easily see revenue of up to $50,000 per year.

Annually: $511.20 per year per patient X 600 patients = $306,720 per year

(Note: Assumes you bill 12 months out of the year)

But—there are very specific things you need to know about the program, and particular requirements you need to follow in order to get paid. Here are some of the things you need to do:

1. Identify your chronic care patients who qualify.

2. Eligible patients include those with two or more chronic conditions expected to last at least 12 months, or until death, that place the individual at significant risk of death, acute exacerbation/decompensation, or functional decline.

3. Only one provider can bill for the chronic care management code in a 30-day period.

4. You must have a signed agreement with the patient allowing you to bill for these services and detailing cancellation rights, copayments and types of services.

5. Among other things, you need to provide 20 minutes or more of chronic care management services per patient per 30 day billing period.

6. You will need to create a patient-centered care plan document compatible with the patient’s choices and values.

7. You must provide either a written or electronic copy of the care plan to the patient.

8. You will need to manage care transitions between and among health care providers and settings.

9. Bill in accordance with CMS requirements using CPT Code 99490, making sure your EHR software provides the information you need to manage and bill for this program.

In addition to the opportunity for physicians to get paid for care they have been providing without reimbursement, this program makes sense in terms of population health. Chronic diseases are among the most prevalent, costly, and preventable of all health problems, as the CDC has pointed out. Multiple studies have shown that care management of this type reduces total costs of care for patients with chronic conditions while improving outcomes.

Get your free step-by-step guide to getting paid under the new Chronic Care Management Code now.

Kathy McCoy, MBA, is Director, Content Marketing, for HealthFusion’s MediTouch® EHR & Practice Management Software. She can be reached at kmccoy@HealthFusion.com.