Several years ago, the Center for Medicare and Medicaid Services released Chronic Care Management (CCM) to assist in improving the quality of chronic illness care which should result in better patient outcomes.
The initial chronic care codes allowed for 20 minutes of non-face to face phone communication with clinical staff per month, which was reimbursed at $42 per month and filed under base code 99490. The patient had to be enrolled in the program and agree to an $8 co-pay. Only one physician could enroll a patient and the patient must have had at least two complex chronic conditions lasting more than 12 months.
Most physicians did not adopt chronic care management due to the low reimbursement and because the physician had to treat all chronic conditions, which excluded most specialists from participating. However, the 2020 Final Medicare Physician Fee Schedule added some provisions to CCM services that could expand participation. While patients needed two complex chronic conditions to qualify for the original program, the 2020 Fee Schedule has added Principle Chronic Management (PCM), which allows a patient with a single high-risk chronic condition lasting more than 12 months to be eligible, thus enlarging the patient pool.
The Physician Fee Schedule also includes G2058 which is an add-on code to allow an additional 20 minutes of time spent in continuous communication with the patient. The add-on code reimburses $37.89 and can be billed concurrently to 99490, two times monthly, per beneficiary. So now the total possible reimbursement for 60 minutes of non-complex CCM is $118.01.
The new opportunities to provide chronic care management and principle care management will allow specialists managing hundreds of patients with chronic conditions, such as COPD or diabetes, to enhance patient engagement while improving the quality of care and receiving a reimbursement worthy of the effort, which will ultimately lead ultimately to better overall health for the patient.
The patients receiving this service feel more connected to their provider and a change in their status is identified quickly. If the practice also has telemedicine, a non-face to face service can quickly become a face to face visit to address concerns. And due to the recent COVID-19 pandemic, these interactions could provide the care needed to protect the chronically ill from being exposed to the deadly virus.
Practices are currently working to provide multiple modes of communication to serve patients without seeing them in the office. Patient portals have failed in the past because many portals were not user friendly or because practices failed to make them valuable by offering valid information through the portal.
However, in times of crisis, such as we have now with COVID-19, it is possible that practice phone lines will be full. In this situation, patients can use the portal as part of the CCM and PCM services to fulfill many of their needs without a physician providing the interaction.
As COVID-19 cases increase across the nation, we have seen monumental change through the emergency expansion of telemedicine. As administrators and physician leaders review the options to expand communication through technology and ongoing medical management, we will be better prepared for crisis situations in the future.
Tammie Lunceford, CMPE, CPC is a Senior Healthcare Consultant with Warren Averett.