Chronic Care Management – A Critical Component of Primary Care NETWORK TMF QUALITY INNOVATION
Medicare Has Initiated a Non-Visit-Based Payment Code for Chronic Care Management
Introducing the Chronic Care Management Learning and Action Network
Care management is one of the critical components of primary care that contributes to better health for individuals and reduced health care expenditures. In recognition of this fact, the Centers for Medicare & Medicaid Services (CMS) introduced a non-visit-based payment code for chronic care management (CCM) services on Jan. 1, 2015. CCM is a technique that clinicians can use to effectively manage their Medicare fee-for-service (FFS) patients who have two or more chronic conditions. The CCM payment method allows eligible clinicians to be reimbursed for offering Medicare beneficiaries, with two or more chronic conditions that are expected to last at least 12 months or until death, with 20 minutes of non-face-to-face care coordination services a month.
A Collaborative Approach According to CMS, 35 million Medicare beneficiaries are eligible to receive CCM services, yet only 100,000 are receiving these valuable care coordination services, based on billing records as of October 2015. When the care of patients with two or more chronic conditions is not coordinated, there are increases in the use of hospital care, use of the emergency department, medication errors, polypharmacy and use of specialty care. To help increase the number of practitioners effectively implementing and providing CCM services to their patients, the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) will leverage existing relationships with physicians, nurse practitioners and physician assistants in Arkansas, Missouri, Oklahoma and Texas. We will provide them with the technical assistance and expertise needed to implement CCM services. As a What is chronic care management? result, practitioners will also be better prepared for the implementation of Care management is one of the critical components of Act primary care that the Medicare Access and CHIP Reauthorization of 2015 (MACRA). contributes to better health for individuals and reduced health care expenditures. This will allow practitioners to participate in one of two payment options:The Centers for Medicare & Medicaid Services introduced a non-visit-based payment code the Merit-based Incentive Payment System or the Advanced Alternative for chronic care management Payment Models. (CCM) services on Jan. 1, 2015. CCM enables clinicians
to be reimbursed for providing 20 minutes a month of care coordination services to Our Goals their Medicare fee-for-service patients who have two or more chronic conditions.
Why Chronic Care Management? 67% of Medicare patients have 2+ chronic conditions
2+
chronic conditions
93%
of Medicare spending is on beneficiaries with 2+ chronic conditions
Providing chronic care management (CCM) to eligible Medicare patients with 2+ chronic conditions means: Using 1 billing code for 20 minutes per month of CCM services Receiving monthly payments for your efforts
Through the Chronic Care Management project, patients will learn more
about their diseases How does this benefit me? and how to appropriately self-manage and participate
the practitioner’s office team. This will result in improved quality of care Medicare’swith payment structure for eligible clinicians providing CCM services can reduceisoverall medical costs to Medicare. to Medicare and beneficiaries approximately $42 per month (Current Procedural payment structurenon-face-to-face for eligible clinicians CCM Terminology Medicare’s Code 99490) for providing care providing and care coordination servicespatients. to Medicare beneficiaries approximately $42 per month Case for services to eligible Read the ChronicisCare Management Business Terminology Code 99490) for providing Participation(Current (PDF) toProcedural learn more about the benefits of offering CCM services and non-face-to-face care and care coordination services to patients with joining the CCM network. (tmfqin.org) two or more chronic conditions.
The TMF QIN-QIO will assist a minimum Join the chronic care management networkof 100 clinicians with identifying
Helping patients better manage their health
Join the Chronic Care Management Network Visit www.TMFQIN.org to join the Chronic Care Management network for free training and support.
eligibleInnovation patients and will help with processes such Organization as billing, documentation The TMF Quality Network Quality Improvement (QIN-QIO) is and service tracking tools as well ask providing educational T e x a s • A r a n s a s • M with i s stools oprocesses u rand i • such Oklahoma • Puerto Rico assisting clinicians with identifying eligible patients and will help Source: Centers for Medicare & Medicaid Services opportunities. as billing, documentation and service tracking tools as well as providing educational Continued tools, resources and events.
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