In January 2015, Medicare began reimbursing health care providers for the time they spend managing ongoing care for patients with chronic conditions (CPT Code 99490). That’s great news, because these important follow-up efforts notably improve patient outcomes by providing ongoing accountability and support.

But as many practices have found, taking advantage of the opportunity can be complicated.

To receive reimbursement for Chronic Care Management (CCM), a practice must meet the following stipulations:

  • Secure patient consent for the program and document that consent
  • Spend at least 20 minutes per month, per patient on non-face-to-face services
  • Document this time by CPT code
  • Maintain comprehensive care plans for each patient
  • Use an electronic health records system (EHR)
  • Record information for submission in a standardized format
  • Provide for and document continuity of care

While many practices already spend extra time with their chronically-ill patients to qualify for reimbursement, documenting that time takes careful planning. Here are four ways you can structure your CCM program both to benefit patients and to meet Medicare’s requirements for submission.

  1. Encourage Participation With an Enrollment Campaign
    To receive reimbursement for Chronic Care Management, your practice must obtain consent from the patient and document that consent has been obtained. An enrollment campaign helps you inform patients about the program and communicate the benefits of participating. Enrollment endeavors may include:
  • Calling campaigns to inform patients about the program and invite them to participate
  • A brochure detailing the program and its benefits
  • A poster in the waiting room to promote awareness of the program
  • Training front office staff to speak about the program with eligible patients

As you talk with patients about the program, be sure they understand that they may decline, transfer, or terminate their involvement at any time. When a patient enrolls, they should receive an explanation of the care plan, understand who will be providing services, give written or oral consent, and receive 24/7 access to their electronic care plan.

  1. Create Online EMR Access for PatientsMedicare requires health care practices to give patients access to a copy of their care plan and to update that plan at least once each year. An online electronic medical record (EMR) portal makes this information easily accessible for patients while also keeping costs low for your practice.While many health care practices already use electronic medical records, these systems usually aren’t set up to collaborate with other providers or document the specific pieces of information required by Medicare in a standardized format. To streamline your Chronic Care Management practices, your EMR should be able to do all of the following:
  • Give patients 24/7 access to their care plan
  • Provide clear instructions for patients
  • Flag qualified Medicare patients
  • Support documentation of care management
  1. Use Time Tracking Software
    In addition to the EMR, you will also need an accurate way to track how much time you spend on non-face-to-face services such as phone calls, coordinating care, and prescription management. Most EMRs do not have this kind of capability built in, so you may need additional time tracking software for this purpose. You can use online tools to track tasks by name or code so that you can see at a glance what you did for each patient and how long it took.
  1. Streamline Billing Paperwork Preparation
    Billing paperwork can be time-consuming, and you need a way to streamline it for efficiency. This may include determining which services may be billed during a given month and whether any codes have been billed which would exclude CCM reimbursement that month (such as transitional care management or hospice care supervision).

The key to efficient, profitable chronic care management is ensuring that every member of your staff is working together toward the same goal. That means educating providers, clinical staff, and office administrators about the requirements of the program and how it benefits both your patients and the practice.

HealthXL®’s Chronic Care Management solutions makes your job easy. We take care of every step so that you can focus on your patients. Contact us today to find out how we can help you serve your patients more efficiently.