As you have probably heard, the final 2015 Medicare physician fee schedule was recently issued by the Centers for Medicare and Medicaid Services (CMS).  The document itself is over 1000 pages long, however, we will be bringing you the highlights and how they affect your practice in a series of blogs.
The biggest news of the release is that, due to a flawed Sustainable Growth Rate (SGR) Medicare payment formula, a Medicare cut is expected.  There is a current patch in place, however, when this patch expires on March 31, 2014, a 21.2% cut is expected.  One of the ways Medicare is proposing for physicians to recoup this money is with the new CCM guidelines included in the 2015 schedule.  ITMedRx has put together the below information to get you started with CCM:
Beginning January 1, 2015, non-face-to-face CCM can be billed at a rate of  approximately $42.60 once per month per qualified patient.  Chronic care management services consist of 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;
  • comprehensive care plan established, implemented, revised, or monitored
CCM services include regular development and revision of plan of care, communication with other treating health professionals, and medication management.
To bill for this fee, practices are required to use a certified EHR, offer round the clock access to staff who have access to the EHR, maintain a designated practitioner for each patient, and coordinate care through transitions to and from the hospital, specialists or other providers. Practices must obtain patients’ consent at least annually to serve as their chronic care provider (sample consent available from ITMedRx by request) and a practice team member must spend at least 20 mins per month performing non-visit based care coordination activities for each patient.
Obstacles in implementing this policy:  beneficiary’s will face a 20% coinsurance for CCM under Medicare Part B and patients may refuse to pay for services they previously received free of charge.
ITMedRx staff is fully trained in CCM billing.  If you would like a CCM billing consultation, we would be happy to counsel you at an hourly rate –  one that’s less than the reimbursement you will receive for just one patient each month!!   (Full billing packages also available; and ask about our bundle deals if you subscribe to two or more monthly services!)

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