Physician Payment for Chronic Care Management Services to Begin in 2015
July 23, 2014 01:59 PM
Beginning in 2015, physicians will be able to receive payment for non face-to-face time a physician and their staff spends managing the care of Medicare patients with two or more chronic conditions. Last year, CMS finalized a separate payment for chronic care management (CCM) codes. For more on the CCM codes, please see NAHC Report, January 31, 2014.
Through this year’s rule, CMS is proposing details relating to the implementation of the new policy, including payment rates.
CMS defines CCM as follows:
“Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”
The 2014 final rule set the scope for CCM to include the following, which remains uncharged with the proposed rule.
24-hour-a-day, 7-day- a-week access to address a patient’s acute chronic care needs.
Continuity of care with a designated practitioner or member of the care team with whom the patient is able to get successive routine appointments.
Care management for chronic conditions including systematic assessment and development of a patient centered plan of care.
Management of care transitions within health care.
Coordination with home and community based clinical service providers.
Enhanced opportunities for a patient to communicate with the provider through telephone and secure messaging, internet or other asynchronous non face-to-face consultation methods.
The CCM codes are in addition to the recently added Transition Care Management codes (TCM 99495-99496), which also reimburses physicians for non-face to face time association with transitioning patients to the community.
CMS proposes to permit both CCM and TCM services provided by clinical staff, that are incident to the services of the practitioner, to be furnished under the general supervision, rather than direct supervision, of the practitioner any time CCM services are provided. General supervision would not require that the physician be present in the office or immediately available while CCM services are provided by the clinical staff.
In the 2014 MPFS final rule, CMS sought comments on standards they intended to develop for CCM. However, CMS has abandoned this idea since many of the proposed standards overlap with the scope and billing requirement for CCM services.
CMS is seeking comment on the method used to determine the relative values units that would set the payment rate for CCM services.
To view the proposed rule, please click here.