As remote care has become more commonly undertaken by providers nationwide, one focus of its use has become providing comprehensive care to patients with chronic conditions. Chronic Care Management (CCM) has emerged as a critical – and convenient – component in ensuring better outcomes and quality of life for those patients.

The Centers for Medicare and Medicaid Services (CMS) acknowledged the importance of CCM by introducing CPT code 99490 to facilitate reimbursement for providers offering these services. Yet, despite the potential benefits, there are numerous challenges that healthcare providers face in effectively offering CCM and utilizing code 99490.

We’ll discuss these here, as well as solutions for providers who see that the advantages of CCM often easily outweigh the negatives.

Challenges in Chronic Care Management

Complex Patient Needs: Patients with chronic conditions typically have complex medical needs requiring a multifaceted approach. Providers need to coordinate care across various specialties, managing a diverse range of medical, social and emotional factors.

Time and Resources: Providing comprehensive chronic care management demands time and resources that some practices might be incapable of allocating. Regular communication, care planning and monitoring require substantial commitment from healthcare teams.

Technology Integration: Effective CCM can involve utilizing healthcare technology for remote patient monitoring, electronic health record (EHR) management, and secure communication with the patient population. Integrating these technologies seamlessly can be a significant challenge, especially for smaller practices.

Patient Engagement: Engaging patients in improving their wellness is critical for successful chronic disease management. But motivating patients to actively participate in care plans, adhere to medication regimens and make crucial lifestyle changes can be an uphill battle.

Reimbursement and Billing: Even with CPT code 99490 created expressly to reimburse providers for CCM services, navigating the billing and reimbursement process can be challenging. Stringent CMS documentation and reporting requirements must be met completely to ensure proper reimbursement.

Challenges with CMS Billing Code CPT 99490

Eligibility Criteria: CMS has defined specific eligibility criteria for CPT code 99490 reimbursement. Patients must have at least two chronic conditions, which are expected to last at least a year or until the patient’s death. Meeting these criteria accurately while adhering to the provided guidelines can be tricky.

Documentation Burden: To bill for CPT code 99490, providers must document at least 20 minutes of non-face-to-face clinical staff time (phone calls, typically) spent per month on CCM activities. This documentation needs to be detailed, accurate, and in line with CMS guidelines, which can impose a heavy administrative burden on providers.

Care Coordination: The code’s requirements emphasize care coordination and regular communication with patients. Coordinating care and maintaining consistent communication can be difficult, especially for patients with multiple specialists involved in their regular care.

Patient Consent and Communication: Gaining patient consent for CCM services and maintaining lines of communication to update them about their care plan requires careful navigation. Just as importantly, ensuring patients understand the benefits of CCM is crucial.

Reimbursement Rate: While CPT code 99490 provides reimbursement for CCM services, some providers find that rate might not fully cover the resources required to deliver comprehensive chronic care management.

A Better Way

With all these challenges involved in CCM and its CPT reimbursement code, why would healthcare providers be even remotely interested in offering it to their patients? Well, they can keep better track of each patient’s wellness without burdening them by coming into the office so frequently. This also helps the practice, freeing up in-house clinical staff to devote more of their time to more urgent needs among their patient population.

The program makes even more sense for providers who enlist a third party to administer it. Patient enrollment, engagement, documentation and even billing should be handled by a vendor experienced in fulfilling these remote care functions. Healthcare providers should be able to focus on understanding their patients’ needs and concerns, not educating them on the intricacies of remote care or having to commit their clinical staff to non-face-to-face interactions, which many have never done before.

That’s where we come in.

HealthXL has handled CCM for providers of various sizes and scopes since 2015. We know how to bring in the right patients for the program, and our own Care Coordinators develop relationships with them to keep them engaged and receptive long-term to your treatment plans. We can also handle the often-bewildering element of billing CMS if you’d like. We know every part of the business, and while the cautions we detailed above might worry you, they don’t worry us.

What’s more, CMS reimbursement also makes CCM profitable for providers who can ensure compliance with the aforementioned guidelines. For instance, consider these recent financials associated with partnering with HealthXL for your CCM program. Providers are routinely surprised – pleasantly – to see that a program designed with their patients’ wellness foremost in mind can also be so lucrative.

Trust the Professionals

It is fair to say that the challenges associated with Chronic Care Management and CPT code 99490 are considerable for most providers. As such, they’re far better off trusting a proven virtual care vendor to address concerns like patient engagement, resource allocation, detailed documentation and even billing challenges.

Contact us if you have questions about CCM, its implementation, and the difference a partnership with HealthXL can make as you prepare for the leap into virtual care. Your patients will be grateful, your available staff bandwidth will improve, and a new revenue stream will help your practice thrive.