Telehealth may be the newest niche on the healthcare block, but its undeniable growth across the country and across many different fields of healthcare means it is here to stay.
So it may be unsurprising to hear that the Centers for Medicare & Medicaid Services (CMS) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) have just released a new educational resource that can make telehealth more understandable and accessible to Medicare enrollees with multiple chronic medical conditions.
“This important initiative builds on our efforts to help providers care for patients with multiple chronic conditions,” said Cara James, PhD, Director of the Centers for Medicare & Medicaid Services Office of Minority Health in a statement included in the CMS’s press release. “We are excited to be working with the Health Resources and Services Administration to reach vulnerable populations.”
“Connected Care” seeks to assist the two-thirds of Medicare beneficiaries with more than one chronic condition
Connected Care: the Chronic Care Management Resource is an educational initiative intended to boost the awareness of services available to Medicare beneficiaries, telehealth services that can assist them in coping with multiple chronic illnesses. It’s also designed to help healthcare providers implement Chronic Care Management (CCM), services that have been covered by Medicare since 2015, also available through telehealth platforms.
The CMS explains, via press release on its website, that “Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease. Two-thirds of Medicare beneficiaries have two or more chronic conditions, and one-third have four or more chronic conditions.”
Providers not always aware of full payment options when billing for remote services
The CMS goes on to state that although many physicians are already using technology for remote chronic care for these patients, the providers are not always aware that they should be billing for separate payments under the Medicare Physician Fee Schedule that would cover these CCM services within the scope of Medicare Part B.
Under the CCM and complex CCM billing codes, providers are paid monthly, on a capitated (per patient, per month) basis. Some of the billing and coding highlights that the CMS wants to make sure participating physicians are aware of include:
- CPT 9949o: this allows practitioners to bill Medicare for 20 minutes or more of non-face-to-face clinical staff time each month (as long as that time is directed by a physician); the goal here is to coordinate care for patients with two or more severe chronic medical conditions that are expected to be long-term (with a duration of a year or more).
- CPT 99487: this is intended for complex chronic care management that would require an hour of staff time and would demand “high complexity medical decision making.”
- CPT 99489: this is a complex CCM add-on code to indicate 30-minute chunks of additional clinical staff time spent on patients’ behalf.
- HCPCS G0506: another add-on code; this one reflects a comprehensive patient assessment and “care planning” at the initiating patient visit.
The CMS has applauded CCM as an integral part of primary care for patients coping with multiple chronic conditions. Also, CCM has the potential for lowering healthcare costs overall.
Beyond telehealth, CCM can be utilized in a variety of settings, including hospitals. Those hospitals that do offer CCM services for outpatients are able to bill Medicare under the Outpatient Prospective Payment System (OPPS). And Medicare would remunerate physicians for time spent orchestrating CCM services using the Physician Fee Schedule.
CMS offers patient and provider resources at go.cms.gov/ccm
Specifically, Connected Care includes the following new resources, available to patients at providers at no cost:
- Educational materials for patients, such as posters and postcards;
- A toolkit designed for healthcare providers that includes suggestions for implementing CCM;
- A “partner toolkit” that offers downloadable information on how to become engaged with the Connected Care
In a statement included in the CMS’s press release, Tom Morris, Associate Administrator, Federal Office of Rural Health Policy at the Health Resources and Services Administration, said: “We are thrilled to be joining CMS to educate health care professionals and patients about the value of chronic care management with the goal of improving overall patient care for millions of Americans and reducing overall health care costs.”
This blog post is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation. For more information/questions regarding any legal matters, please email [email protected] or call 310.203.2800.