Chronic Care Management The Future Is NOW.
58 Million 58 MillionIn 2017,
Medicare Beneficiaries1
~66%Approximately 2 out of 3 Medicare beneficiaries have multiple chronic conditions.2
$709.4 Billion Gross Medicare Spending in 20171
14%
23%32%
32%
Number of Chronic Conditions
6+4 to 52 to 30 to 1
% of Medicare Beneficiaries by Number of Chronic Conditions3
IMPACT Care Quality and Grow Revenue with CCM.
CMS establishes CCM program CPT Code 99490to address chronic conditions in Medicare patients
CMS lifts administrative burdens presented in 2015 & 2016 as barriers to entry and improve payment accuracy
CMS adds FQHCs and RHCs, and they are now able to bill CPT Code 99490
CMS enhancespayments and simplifies billing for FQHCs and RHCs. New HCPCS codesfor CCM service for theseorganizations
Medicare Pays for Non-Face-to-Face Chronic Care Management Services (CPT Code 99490)
Note: Overall healthcare spending per beneficiary has decreased year over year from 2015 to 2016.5
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Number of Physicians in the Practice
$42.842018 National Average
Reimbursement4
CPT Code 99490
5
3,279
21.85%
66%
National Average Patients Per Physician
National Average of % of Physicians’ Patients Covered by Medicare
% of Medicare Patients with 2+ Chronic Conditions
CPT Code 99490Revenue Potential Example
= ~$1,200,000Total Annual Revenue Potential
(~$101,000 x 12 Months)
CPT Code 99490Program Highlights
Medicare Beneficiaries Requirements2 or more chronic conditions expected to last 12+ months
Technology RequirementsStructured recording of demographics, problems, medications, and allergies
Service Requirements20+ minutes of non-face-to-face care management services a month; access to urgent care service 24/7; medication reconciliation; build comprehensive care plan
Billing RequirementsOnly one provider per patient can bill;CCM services can be billed only once per member per month
Download the 2018 CCM eQGuide
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1 https://www.hhs.gov/about/budget/fy2017/budget-in-brief/cms/medicare/index.html2https://www.hhs.gov/ash/about-ash/multiple-chronic-conditions/about-mcc/index.html 3https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf 4https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=3&H1=99490&M=55https://innovation.cms.gov/Files/reports/chronic-care-mngmt-finalevalrpt.pdf