The Chronic Care Management (CCM) initiative incentivizes providers to help patients better manage their chronic conditions. Until the Centers for Medicare and Medicaid Services (CMS) rolled out the CCM initiative in 2015, it was difficult to motivate primary care providers, who are already stretched thin, to provide additional services for which they would not be paid. Furthermore, many providers were already offering some elements of chronic care management, uncompensated, in an effort to help their patients. Chronic care management provides health benefits to patients and financial benefits to providers, but in order to get paid, it’s important for your team to perform chronic care management documentation according to CMS guidelines for the program.
CCM Documentation Requirements
In order to bill for CCM, you must provide the following documentation:
- A patient’s verbal or written agreement prior to providing or billing for CCM services, documented in the patient’s record.
- Document that appropriate clinical staff spent at least 20 minutes of non-face-to-face time providing CCM services within a given month (note that an initial visit is required for new patients or patients that have not been seen in the past year, and is billed separate from CCM).
- Record the date, time spent, name of provider, and the services provided.
You’ll also need to:
- Include the diagnosis codes for the patient’s chronic conditions.
- Document the time spent in total minutes, not timestamps, and do not round up.
If a provider’s office meets the documentation requirements above, you can then bill Medicare using CPT code 99490. This may only be billed once per month per participating patient. For more complex CCM cases, or for extended care coordination time, you may need to fulfill extra service/documentation requirements (for a full FAQ on billing for CCM billing requirements, check out this handy guide from CMS).
Best Practices for Chronic Care Management Documentation
In order to ensure that you are tracking and billing appropriately for CCM, there are several best practices to adhere to:
- Have the physician provide information about the benefits of CCM at an office visit and explain how the program works. Give the patient information that can be taken with them that includes the 24/7 phone number available to all patients participating in the CCM program.
- If the patient agrees to participate in the program, document the consent in the EHR with the following information:
- The availability of CCM services
- Any applicable cost-sharing, including the patient’s deductible, co-pay, and co-insurance
- That only one practitioner can furnish and be paid for CCM services during a calendar month
- The right to stop CCM services at any time (effective at the end of the calendar month)
- Create a patient-centered care plan with provider input.
- Create a workflow and template for tracking time spent on CCM activities, collaborating with other members of the care team, and prescription management and medication reconciliation. Many EHRs do not yet support CCM-related activities; it’s important to use a technology platform or third-party vendor that captures and submits the appropriate data through certified EHR technology (CEHRT) without creating duplicative work for your staff.
- Ensure that the dates of service match the calendar month when you are billing.
Several CCM billing guidelines require specificity regarding which calendar month services were rendered.
Seamless CCM Documentation With BlueFish
Other CCM vendors capture encounter documentation in their own proprietary apps, and then send that information to the practice to be imported into the EHR. BlueFish is committed to making the CCM process seamless for our clients, and we ALWAYS complete encounter documentation in your practice’s EHR. BlueFish provides the highest level of CCM services, supporting your patients and practice team with:
- The ability to provide end-to-end CCM services with appropriately licensed staff, including patient sign-up, care plan creation, care provided by nursing staff, and billing
- The ability to provide your patients with 24/7 access to and continuity of care
- The ability to seamlessly extend your care team, with a service tailored to meet the needs of your patients and clinical staff without disrupting your workflows.
- The ability to easily access any care given with all documentation being completed within the provider’s EHR.
If you’re looking for someone to partner with for CCM services, BlueFish can help you build a successful chronic care management program.