Understanding Chronic Care Management...1 © Greenway Health, LLC. All rights reserved. Confidential...

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Understanding Chronic Care Management

Lauren Mazza

Product Marketing Specialist


Agenda

• What is the CCM fee?

• Billing requirements and eligibility

• CCM implementation

• Proposed regulatory changes


Poll question

Have you ever billed for the Chronic Care Management service before?

a) Yes, but we didn’t get too many patients enroll

b) Yes, and we were fairly successful

c) No, but we’re looking into it

d) No, and we’re not interested in the near future


OVERVIEW


Taking the first step is hard

MACRA, MIPS CPIA

CCM

PCMH

Sharing data is complex

Obtaining patient consent

Declining reimbursement

Care coordination


Where CCM fits in population health

% Medicare

Population

5%

CCMExisting Case

Management -

the “sickest of

the sick”

Healthcare Costs

Manage disease in ~70% of Medicare patients who are at moderate risk

Prevent the progression of chronic disease

Avoid unnecessary ED visits/hospital admissions

Healthy

Seniors


CCM benefits

Expanded access to clinical services and health record

Patient satisfaction

Reallocate questions about self management and patient education

Improved population health, patient education, and outcomes

Reimbursable opportunity, $42 per qualifying patient per month

A

B

C

D

E


Trends over time support the role of engagement in generating clinical outcomes

mm

Hg

Number of weeks after activation

Systolic Blood PressureBaseline values ≥ 135 mm Hg

mg

/dL

Blood GlucoseBaseline values ≥ 140 mg/dL


Medicare unplanned re-admission rate:RevUp CCM patients vs. all Medicare Specific Readmission Measures: Acute Myocardial Infarction, Chronic Obstructive Pulmonary Disease, Heart Failure, Pneumonia, Stroke, Coronary Artery Bypass Graft, Total Hip and/or Total Knee Surgery

Note: All Medicare column as filed with Medicare by Gulfport - 2014

#ofPatients

%

#Re-Admissions

%

3529 ~12,000

MemorialHospitalatGulfportAllMedicareCCMPatients

15.19%

#ofAdmissions

7.66%

34

3080

468

444

12.60% 25.70%


BILLING REQUIREMENTS AND PATIENT ELIGIBILITY


CCM Requirements to Bill (from CMS website)

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient

• Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

• Comprehensive care plan established, implemented, revised, or monitored

– Create a patient-centered care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment, and an inventory of resources (a comprehensive plan of care for all health issues)

– Document its provision in the medical record.

• A practitioner must inform eligible patients of the availability of and obtain consent for the CCM service before furnishing or billing the service. Some of the patient agreement provisions require the use of certified Electronic Health Record (EHR) technology.


CCM Requirements to Bill (from CMS website)

• CMS requires the use of certified EHR technology to satisfy some of the CCM scope of service elements. In furnishing these aspects of the CCM service, CMS requires the use of a version of certified EHR that is acceptable under the EHR Incentive Programs as of December 31st of the calendar year preceding each Medicare PFS payment year (referred to as “CCM certified technology”).

• Access to Care

– Ensure 24-hour-a-day, 7-day-a-week (24/7) access to care management services

– Provide enhanced opportunities for the patient and any caregiver to communicate with the practitioner regarding the patient’s care. Do this through telephone, secure messaging, secure internet, or other asynchronous non-face-to-face consultation methods, in compliance with the Health Insurance Portability and Accountability Act (HIPAA)

– Manage care transitions between and among health care providers and settings, including referrals to other providers, including: coordinate care with home and community based clinical service providers.


Who’s eligible, and who can bill for CCM?

Examples of qualifying conditions

Alzheimer’s disease and related dementia Depression

Arthritis Diabetes

Asthma Heart failure

Atrial fibrillation Hypertension

Cancer Ischemic heart disease

Chronic Obstructive Pulmonary Disease Osteoporosis

Various providers can offer the service. All

providers must be licensed in the state that the

patient receives care.

• Physicians

• Certified nurse midwives

• Clinical nurse specialists

• Nurse practitioners

• Physician assistants


CCM scope of service

Assessing the patient’s health, mental, and psychosocial needs

Ensuring all patients receive recommended preventative services systematically

Medication reconciliation and overseeing a patient’s self-management of medications

Managing a patient’s transitions of care between providers and healthcare settings, such as a following up with a patient after a hospital discharge; creating and sharing as needed a care plan based on a patient’s comprehensive needs


Billing restrictions

C

B

AA

B

C

One patient, one provider

One practitioner per patient per month may bill for the service

Program overlap

Cannot bill for CCM services that overlap with other programs, such as CPC+

Skilled nursing facilities

Cannot bill for services provided to SNF patients or hospital patients in Medicare Part A


CCM IMPLEMENTATION


Sample enrollment workflow

Patient is flagged as eligible in EHR based on insurance, discus

CCM during E/M level 4

Provider confirms 2+ chronic conditions and recommends

CCM program

Patient consents


Ongoing program implementation

Monthly scheduling,

outreach

20 minutes of care

Review and update care plan, update

patient

File claims monthly


REGULATORY CHANGES


New codes: 99489 & 99487

Qualifying patients must have two or more chronic conditions that will last for at least 12 months or until death

1

The conditions place the patient at significant risk of death, acute exacerbation/de-compensation or functional decline

Establishment or substantial revision of comprehensive care plan; and moderate or high complexity medical decision making

60 minutes of clinical staff time directed by a physician or other qualified HCP

2

3

4


More flexibility in 2017 Physician Schedule

Initiating visit only for patients not seen

for over a year

Initiating visits

Care plan availability

Care plan no longer required to be

available remotely, only need a way for practices to contact

HCPs 24/7

Sharing information

outside the practice

More flexibility in sharing electronic care information

outside the practice

Managing transitions

No need to use specific technology

to manage care transitions, only

need to respond in a timely manner

Patient consent

Written consent no longer required


Supervision: FQHCs and RHCs

Direct supervision General

supervision


Commercial payers

Many commercial payers also reimburse

Less stringent requirements

15%-20% higher

payments than Medicare


Succeeding in reimbursement reform

Care coordination

Improve reimbursement across programs

Managed care

ACO

MACRA: MIPS & Advanced APMs

Control costs

Raise quality

Engage beneficiaries

PCMH

CPC+


Enroll patients:• 2+ chronic conditions• Eligible payer• Consent form signed• Assign Care Program of

CCM-Enrolled

Practice

Patient enrolledPatient enrollment

validated

CCD extracted for diagnoses and goals

Documents updated • RevUp care plan• Evidence of care

• Patient reported vitals

CCM Services provided

during month

Patient CCM minutes, diagnosis codes, CPT

codes aggregated

Patient Imaging:• Care plan • Evidence of care• Patient reported vitals

Documentation sent

Billing information sent

Billing:Process claimsCollect patient copayment

ServiceCCM services model


Poll question

Would you like a sales representative to contact you about Greenway Care Coordination Services?

a) Yes

b) No


QUESTIONS


Additional resources

• Advancing Care Information webinar

• 2017 Changes to CCM – MLN

• CCM FAQ

https://www.greenwayhealth.com/webinar/advancing-care-information-meet-your-objectives/

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagementServicesChanges2017.pdf

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Payment-Chronic-Care-Management-Services-FAQs.pdf

Date post:	17-Oct-2020
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