Practices may wish to consider or revisit chronic care management (CCM) services.  CMS states they have proven value in improving the quality of care and reducing overall cost.  These services can be challenging to implement.  However, they may be ideally suited for the current pandemic.

Many practices have had challenges keeping their providers fully engaged in patient care activities.  CCM creates a new revenue stream for practices. Reimbursement for these services has been significantly increased over the past 5 years.  New services have been added that make CCM a potential lifeline for practices that have patients with two or more chronic conditions that would benefit from additional focused care.

A common theme is the under-utilization of mid-level providers (i.e., NPs, PAs, CNSs) forcing many practices to consider staff reductions.  Getting you mid-level and clinical staff members fully engaged with CCM and other remote services has the potential to avoid lay-offs while providing benefit to your neediest patients.  For example, CCM includes a code (99491) that reimburses at $85 for when the physician, NP, PA, or CNS personally provides 30 minutes of CCM services in a month.  Conservatively, a PA that averages 10 hours per week providing CCM services may generate up to $5,000/month in additional revenue for the practice.

CCM services do not conflict with office/telehealth visits and other remote services.  They are oriented towards primary care providers or specialists that oversee all aspects of the patient’s care.  Specialty practices should consider the very new Medicare program titled “Principal Care Management” (PCM) services as these are oriented towards specialty practices.

Experience has provided us with best-practices for implementing CCM. We  feel that recent changes to CCM requirements and reimbursement will make a difference when implementing this service.  It may also allow practices to mitigate losses from reductions in other services.

We provide low-cost CCM assessment, implementation and compliance services, led by a physician coding professional.  Please contact us to discuss best practices for implementing CCM services, including strategies to enroll patients and receive high satisfaction scores.

More information on CCM requirements, updated for 2020, is available here.