Frequently Asked Questions

Provider

Billing Related
BILLING CODE PAYMENT (NONFACILITY RATE) CLINICAL STAFF TIME CARE PLANNING BILLING PRACTITIONER WORK
CCM (CPT 99490) $43 20 minutes or more of clinical staff time in qualifying services Established, implemented, revised, or monitored Ongoing oversight, direction, and management Assumes 15 minutes of work
Complex CCM (CPT 99487) $94 60 minutes Established or substantially revised Ongoing oversight, direction, and management + Medical decision-making of moderate-high complexity Assumes 26 minutes of work
Complex CCM Add-On (CPT 99489, use with 99487) $47 Each additional 30 minutes of clinical staff time Established or substantially revised Ongoing oversight, direction, and management + Medical decision-making of moderate-high complexity Assumes 13 minutes of work
CCM Initiating Visit* $44-$209 - - Usual face-to-face work required by the billed initiating visit code
Add-On to CCM Initiating Visit (G0506) $64 N/A Established Personally performs extensive assessment and CCM care planning beyond the usual effort described by the separately billable CCM initiating visit
  • Medicare Part B, some Medicare Advantage Plans.
  • Practitioners should consult the CPT definition of the term "clinical staff." In addition, time spent by clinical staff may only be counted if Medicare's "incident to" rules are met such as supervision, applicable State law, licensure and scope of practice. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff can be counted. If the billing practitioner provides the clinical staff services themselves, the time of the billing practitioner may be counted as clinical staff time.
  • No, these times should be considered like the typical times for evaluation & management (E/M) office visits. They are assumed times, established through physician survey by the American Medical Association when the codes were created and valued, for how much time the billing practitioner spends himself or herself each month, but are not exact times. The billing practitioner's time could be spent in activities such as directing clinical staff; personally performing clinical staff activities; or in the case of complex CCM, performing moderate to high complexity medical decision making.
  • Yes. CCM is priced in both facility and non-facility settings. The POS on the claim should be the location where the billing practitioner would ordinarily provide face-to-face care to the beneficiary.
  • No, as provided in the CY 2014 PFS final rule (78 FR 74424), a new consent is only required if the patient changes billing practitioners, in which case a new consent must be obtained and documented by the new billing practitioner prior to furnishing the service.
  • CCM includes, in large part, activities that are not typically or ordinarily furnished face-to-face with the beneficiary and others, such as telephone communication, review of medical records and test results, and coordination and exchange of health information with other practitioners and providers.
  • CPT code 99490 (non-complex CCM) describes a minimum number of minutes of service (there is no maximum). Therefore, the practitioner may only bill one unit and one line item of CPT 99490 per calendar month.
  • Yes. If services are covered under Medicare Part B, Medigap insurers do not have authority to deny the coinsurance, copayments or other benefits that are payable on behalf of the beneficiary under the provisions of the Medigap insurance contract. Private insurers providing standardized Medigap plans agree to accept a notice of Medicare payment as a claim for the payment of benefits under the Medigap plan, unless the Medigap policy itself has a deductible that has not yet been met (e.g., high deductible Plan F).
  • At any time after the 20 minute threshold has been surpassed for a patient. It is advisable to bill at a predictable time every month to ensure predictable cash flow.
Program Related
  • Chronic Care Management (CCM) services by a physician or nonphysician practitioner (Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist and/or Certified Nurse Midwife) and their clinical staff, per calendar month, for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until death, and that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.
  • CCM is a critical component of care that contributes to better health outcomes and higher patient satisfaction.
  • CCM is person-centered.
  • CCM requires more centralized management of patient needs and extensive care coordination among practitioners and providers.
  • Ongoing CMS effort to pay more accurately for CCM in "traditional" Medicare by identifying gaps in Medicare Part B coding and payment (especially the Medicare Physician Fee Schedule or PFS).
  • Eligible beneficiaries have:
    • Two or more chronic conditions expected to last at least 12 months or until death, that place them at significant risk of death, acute exacerbation, or functional decline
    • No other diagnostic limitations
    • A given beneficiary receives either non-complex CCM (CPT 99490) or complex CCM (CPT 99487,9) for a given month
  • Alzheimer's disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Deprionession
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS
  • Other
  • Physicians, Physician Assistants, Clinical Nurse Specialists, Nurse Practitioners, and Certified Nurse Midwives. Only 1 practitioner can report CCM per month.
  • Use of Certified EHR
  • Continuity of Care with Designated Care Team Member
  • Comprehensive Care Management and Care Planning
  • Transitional Care Management
  • Coordination with Home and Other Clinical Providers
  • 24/7 Access
  • Enhanced Communication (phone, email)
  • Consent
  • Verbal consent is acceptable. – Initiating visit only required for new patients or those not seen within a year prior to the commencement of CCM (previously all patients required an initiation visit).
  • Access to care 24/7
  • Continuous conversation with designated provider or care member of care team. Conversation can be related to patient prescription compliance, chronic condition monitoring, or general well-being.
  • Creation and update of care plan.
  • Management of care transitions to other care providers and settings.
  • Coordination with home and community based clinical services.
  • No, they be a cumulation of multiple interactions or activities dedicated to patient care.
  • Yes. All clinical staff and the subject billing practitioner can provide service.
  • Not limited to:
    • Creation, revision, implementation, sharing of care plan.
    • General phone interview about condition, goals, and other general well-being questions.
    • Transition from specialists, home, or other community related clinics.
    • Medication reconciliation and compliance.
    • Appointment scheduling.
    • Lab review and/or discussion.
    • Any other activity dedicated to patient.
  • If you use a certified EMR, you have a structured form of patient health information.
  • Care plan can include, but is not required to include:
    • Problem list
    • Expected outcome & prognosis
    • Measurable treatment goals
    • Symptom management
    • Planned interventions
    • Medication management
    • Community/social services ordered
  • Yes, once created you must share with the patient. Only on demand from the family or other providers.
  • Utilizing a software solution such as Chronica will allow you to easily document and bill all CCM services provided.

Product

  • To ensure your success we conduct orientation, onboarding and support.
  • Orientation
    • Introduction to the Chronic Care Management Program
    • Introduction to billable activities, effective care coordination, and the Chronica software.
    • Enrollment best practices.
  • Onboarding
    • Implementation of Chronica Software in Clinic.
    • Collaborative reporting process creation with clinical staff.
    • Going live with your CCM program.
  • Continuous Support
    • Weekly check-ins for 1st month.
    • Quarterly thereafter.
  • Whether incidental or scheduled, it is easy to track each interaction into the Chronica platform. You can schedule short conversations with patients, track incidental by simply typing in the patient's name, or wait until you're ready to enter Chronica to enter your data. Chronica is always on and always available for date input. Once you're ready to bill, just navigate to documentation and print out a billable report for your billing staff.
  • We work with your staff to develop a tangential process that will only add 1-2 steps in your current work flows. We continue to refine this process with you so there is no loss in time for billing practitioners or clinical staff. We understand practices are very busy so our software allows for ease of use and documentation.
  • Chronica can integrate with most commercial certified EMRs. Just let us know which one you have and we are almost certain we can integrate and automate much of the work flow.
  • Depending whether its incidental or scheduled, billing practitioners or clinical staff simply search for a patient and jot down the time of the interaction and any related notes. We automatically save the time and the note and let you get back to what you were already doin
  • We offer EMR integration which makes the entire process or automated or we will have our staff enter all patients into Chronica who are eligible for chronic care services. There will be no burden placed on your staff.
  • We've automated a significant amount so an enrollment process can be relatively short. Depending on the patient, it can be anywhere from 5-20 minutes.
  • During our upload of eligible patients we utilize ICD-10 codes to determine which patients have 2+ chronic conditions.
  • As a self-service platform, we allow you to manage your own CCM program. Consequently, this saves you time, money, and improves patient enrollment and care. In terms of financial return, your return on investment with Chronica is much higher compared to what it would be a turn key vendor. Further, because your enrolled patients are speaking with friendly voices, the enrollment will likely be higher. Our goal is to help you keep more of what you deserve, and with our solution, we know you will.

Patient

  • You will receive additional attention from your physician, allowing you to be ensured that you are receiving continuous care and remain healthy.
  • Mostly no, if you have wrap around coverage from a private insurer, they will cover the deductible. Otherwise, the monthly fee is $8.
  • Yes, depending on the insurer.
  • Let your physician know that you are willing to be in the program and want to get enrolled.
  • If you have 2 or more chronic conditions you are eligible.
  • Let your practice know you want to opt-out.

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