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Understanding the Chronic Care Management Codes

As Related to the CMS Proposed FY2015 Medicare Physician Fee Schedule

BY CHERI LATTIMER, RN, BSN, EXECUTIVE DIRECTOR CMSA

On  July 13, 2014, the Centers for Medicare & Medicaid services (CMs) issued a proposed rule that would update payment policies and payment rates for services furnished under the Medical Physician Fee schedule (MPFs) on or after Jan. 1, 2015. among the many provisions and changes are the Chronic Care Management (CCM) codes. CCM is a unique PFs service designed to pay separately for care coordination services that are not face-to-face and are furnished to Medicare beneficiaries with two or more chronic conditions.

SO WHAT DOES THE CODE SUPPORT?

The code is an initial step in supporting physicians and their practice in managing Medicare patients with multiple chronic conditions who are at the highest risk of functional decline or death. the work time associated with providing CCM services is being proposed for 20 minutes of clinical labor time. the provision also indicates that at least 20 minutes of CCM services must be furnished during a 30-day billing period. although only a physician or advanced practice nurse are able to bill these new codes, it has been determined that, with input from stakeholders and the nature of care management services, many aspects of these services will be provided by clinical staff. this means that within the physician practice, social workers, nurses and case managers can deliver these services to ensure that patients’ and families’ medical, psychosocial and mental health needs are met.

CCM services are expected to be available to the beneficiary 24 hours a day and 7 days a week to address the patient’s chronic care needs. Practices using this code will be required to provide beneficiaries with a means to make timely contact with health care providers whenever necessary to address chronic care needs regardless of the time of day or day of the week. In cases when the need for contact arises outside normal business hours, it is likely  that the patient’s initial contact would be with clinical staff employed by the practice and not necessarily with a practitioner.

WHAT DOES THIS MEAN FOR CASE MANAGERS?

It is encouraging that within the physician practice setting, CMs acknowledges, understands and is moving forward to support the services of case management, care management and care coordination. It is disappointing that professional case managers are not able to bill these codes independently; however, it is forward progress that CMs recognizes the need for payment of chronic care management services and that those services are in many cases provided by clinical staff. the period for public comment on the 2015 Physician Fee schedule and the CCM codes is open through sept. 2. CMsa will provide comments and consideration to CMs. since this article is being written prior to the closure of the comment period, I am unable to substantiate the content of the comments CMsa will provide, but a follow-up article will be posted after the close of the comment period.

It is extremely important that in the coming months we begin to strategize how qualified professional case managers can be recognized as providers of chronic care management and case management services and work toward achieving Medicare billing status. the call for action here is not to give up or agree to the status quo but to continue to validate the services professional case managers provide, highlight the qualifications of the professional case manager, and show the impact and outcomes we bring to patients and their families in managing chronic care needs throughout the continuum of care. the more we are united and committed in this action, the greater the opportunity is to make the difference. ■

REFERENCE
1) www.cms.gov/Medicare/Medicare-Feefor- Service-Payment/PhysicianFeeSched/ PFS-Federal-Regulation-Notices-Items/ CMS-1612-P.html

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