Medicare Pays for Chronic Care Management That Uses an EHR

Medicare now pays for chronic care management (CCM) services, if your practice has a certified electronic health record (EHR).

 As of Jan. 1, 2015, Medicare pays separately under CPT code 99490 for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

CPT 99490 is defined as follows: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: 

• 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; and
• Comprehensive care plan established, implemented, revised, or monitored.

 The CCM service as laid out by Medicare to qualify for payment is extensive, and some components require the use of a certified EHR or other electronic technology. For CCM payment in calendar year 2015, you may use EHR technology certified to either the 2011 or 2014 edition(s) of certification criteria. Here is where the technology plays a role:

 Clinical summaries

• You must create a structured recording of demographics, problems, medications, medication allergies, and structured clinical summary records. A full list of problems, medications, and medication allergies in the EHR must inform the care plan, care coordination, and ongoing clinical care.
• You must manage care transitions among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit or discharge from a health care facility. You must format clinical summaries according to certified EHR technology, although you may exchange/transmit the clinical summaries as needed electronically by other means, such as encrypted email (but not fax).

 You can use the clinical summaries toward meeting meaningful use measure 12 of Stage 1 or measure 8 of Stage 2 

Patient-centered care plan information

You must create a patient-centered care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment and an inventory of resources and supports. You must at least capture electronically — you don't have to use certified EHR technology — the care plan information, making it available 24/7 to all clinical staff within the practice whose time counts toward the 20 minutes per month to bill the CCM code. You also must share care plan information electronically (can be via encrypted email or other electronic means but not fax) as appropriate with others on the care team outside the practice.

Documentation

You'll need to document several interactions in the EHR using certified EHR technology:

• The provision of the care plan to the patient as required. You can give the patient either a written or an electronic copy of the care plan. The latter would count toward meaningful use measure 11 (PDF) of Stage 1 or measure 7 (PDF) of Stage 2.
• The patient's written consent and authorization.
• Communication to and from home- and community-based providers regarding the patient's psychosocial needs and functional deficits.

For more information about getting paid for CCM services, see:

• The Centers for Medicare & Medicaid Services' 11-page guide and FAQs, and
• The American College of Physicians Chronic Care Management Toolkit.

If you have questions about coding, billing, or meaningful use, call the TMA Knowledge Center at (800) 880-7955 to reach a TMA expert. Visit TMA's Medicare Resource Center for Medicare information and resources

Take note: Attend the 2015 Novitas Solutions Medicare Symposium and get all your Medicare questions answered by Novitas staff! Registration is open for the Frisco session on Nov. 5.

Published May 13, 2015