Chronic Care Management Program

How Can We Help

It has never been more important to improve your patients’ outcomes. There are a lot of questions about Chronic Care Management (CCM) implementation including required elements, billing, software, staff, outsourcing and more. Dr. Koyfman has been consulting large and small companies on Chronic Care Management (CCM). Click here to schedule introduction call @ https://calendly.com/dr_irina/30min

What is Chronic Care Management (CCM)

Chronic Care Management (CCM) is a Medicare program that offers significant monthly reimbursement for the time providers and their staff spend helping patients between office visits.

Required Elements of CMS compliant CCM program

Multiple requirements exist to bill CCM. The requirements are complex and address patient’s eligibility, provider eligibility and billing components.

One must manage care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and followup after discharges from hospitals, skilled nursing facilities, or other health care facilities.

Care manager must also coordinate and communicate with home- and community-based clinical service providers. Furthermore, CMS states that care management for chronic conditions including systematic assessment of the patient’s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of patient self-management of medications

Benefits

CCM, done right, is the best way to increase your practice revenue along with patients’ satisfaction. A health care provider who can enroll 500 CCM patients can generate an add additional $20,000+ per month or $250,000+ per year of revenue.

Chronic Care Management Billing Codes

Chronic Care Management is billed using Current Procedural Terminology (CPT) codes. Specified codes determine and categorize treatment procedures, care services, and billing rates.

Code

Description

Summary Requirements

Payment Average

HCPCS G0506

Comprehensive
Assessment &
Care Planning

Patient enrolled in CCM
Systematic assessment & care planning
personally performed by the billing provider
Add-on code to the standard E&M code
(99212-99215), AWV or IPPE initiating visit

$62

CPT 99490

Standard CCM

Min of 20 minutes of care management outside of office visits performed by clinical staff

$64 (increased from $41)

CPT 99439
(New in 2021)

Non-complex
Add on x 2

Additional 20 minutes of “non-complex” CCM

Reportable up to 2x per month (after 99490)

$47 (increased from $38)

CPT 99487

Complex CCM

60+ minutes of care management outside
office visits

$130 (increased from $92)

CPT 99489

Complex Add on

Billed incrementally for each additional 30 minutes spent beyond the first 60 minutes for Complex CCM case

$68 (increased from $44)

CPT 99491

Provider preforming CCM

30+ minutes of care management outside of
office visits
Provided personally by a physician or other
qualified healthcare professional

$83 (increased from $82)

CPT 99437
(New in 2022)

Provider preforming CCM Add On

Additional 30 minutes of care management outside of office visits

$59

 

Chronic Care Management services and CPT 99490

CPT 99490 describes activities that are not typically or ordinarily furnished face-to-face, such as telephone communication, review of medical records and test results, and consultation and exchange of health information with other providers.

Activities that are appropriate for CCM are (not all inclusive list):

•
Assessment of needs (functional, psychological, psychosocial, SDOH, instrumental, environments, care giver and more).
•
Coordination of Care.
•
Communication with provider.
•
Communication with patient and or caregiver.
•
Communication with any providers involved in care (specialists, HHA, DME, Pharmacy).
•
Patient education.
•
Chart review.
•
Medication management (reconciliation, education, help in obtaining, adherence and more).
•
Identifying and managing gaps in care (preventative services, maintenance appointments).
•
Identifying deficiency and managing self-care.
•
Empowering patient to get involved in care.

Chronic Care Management (CCM) and Principal Care Management (PCM)

CCM is the program for people with 2 or more chronic conditions, however 6 in 10 Americans have at least 1 chronic condition. PCM mimics CCM, however there are some notably difference you should know about.

Chronic Care Management intended for Principal Care Management intended for
People with 2+ chronic conditions People with only 1 chronic condition
Mostly for Primary Care Providers Mostly for Specialists
Requires Comprehensive Care Plan Disease specific Care Plan
Minimum billing is 20 minutes (CPT 99490) Minimum billing is 30 minutes (99424/5)

How Can We Help

It has never been more important to improve your patients’ outcomes. There are a lot of questions about Chronic Care Management (CCM) implementation including required elements, billing, software, staff, outsourcing and more. Dr. Koyfman has been consulting large and small companies on Chronic Care Management (CCM). Click here to schedule introduction call @ https://calendly.com/dr_irina/30min

Testimonials

Dr. Irina Koyfman helped implement Chronic Care Management Services for my practice - home-based primary care practice. I was not aware of CCM prior and was not billing for all the services I was providing for my patients between visits. Ever since I have implemented what Dr. Koyfman had suggested, I have been able to spend more time with my complex patients, increased my revenue, increased patient satisfaction and overall, I increased my work-life balance. I recommend every primary care provider implementing CCM and hiring Irina as a very capable consultant.

Slava K, Nurse Practitioner, President, Maryland.

Dr. Irina Koyfman Irina has been providing consulting services to ChronWell on Chronic Care Management program for several months. From the very first interaction, it is obvious that her goal as a consultant is to delight the customer and bring value every step of the way. She is knowledgeable, innovative, thinks outside the box, is quick to grasp the context of the organization and provide relevant guidance. She brings a unique blend of business savvy and clinical expertise.

Marina S, VP or Product Management, Florida.

Dr. Koyfman had helped to implement Remote Patient Monitoring Program in my practice, for which I am very grateful. Dr. Koyfman has a way to explain complex issues, so I could understand and quickly implement them. She also told me about few things that I could add (annual wellness visits and cognitive assessments and care plans) and immediately I was able to do so. Dr. Irina Koyfman is generous with sharing her knowledge. I paid for RPM but received so much more.

Vicky, B. NP CEO, Maryland.

Dr. Irina Koyfman came to my mother’s house to assess her cognitive status and she was able to shade light on her diagnosis of moderate dementia and helped us with understanding of the disease progression, treatments, resources, and plan for the future. Dr. Koyfman was very kind with my mother, she was patient with us and we just loved her bed-side manner and her knowledge. Although, it is not easy to know that your mother is not well, but it is very helpful to have someone like Dr. Koyfman on our side.

Lyudmila, daugther of a patient, Maryland.