Chronic Care Management: Developments and New Requirements for Hospitals and Physicians

Following the publication of the 2015 Medicare Physician Fee Schedule Final Rule in which the Centers for Medicare and Medicaid Services (CMS) began allowing for reimbursement for provision of chronic care management (CCM) services, there have been a number of important developments around CCM which impact both hospitals and physicians. In mid-February of this year, CMS held a call as part of the Medicare Learning Network (MLN), and the call focused on answering questions about and clarifying confusion around payment for CCM services under 2015 Medicare Fee for Service. In May 2015, CMS, again through the MLN, issued guidance in the form of a ten page white-paper which outlines the key components and requirements for the CCM services. Also in May 2015, CMS issued a set of frequently asked questions and answers about billing Medicare for CCM services. Finally, in early July, CMS issued a proposed regulation that updates payment policies under the Medicare Physician Fee Schedule (PFS) for 2016, and as part of that proposed regulation, came proposed changes to the requirements for CCM. As CMS continues to develop and refine requirements for CCM, it is important to understand the proposed (and in the future, potentially finalized) changes and the ways in which such changes impact the provision of CCM services.

The majority of the suggested changes around CCM services in the July Medicare PFS proposed regulation affects hospitals and the ability of hospitals to bills and receive payment for CCM services. First, CMS proposed that a hospital would only be able to bill for CCM services when the services were furnished to a patient who has either been admitted to the hospital as an inpatient or has been a registered outpatient of the hospital within the last twelve months. Second, CMS proposed that if a hospital is billing for CCM services for a patient, the hospital must meet the same requirements which providers must meet to bill for the services, such as having the patient’s consent to have CCM services provided documented in the patient’s medical record that the hospital can access. In addition, only one hospital can be paid for provision of CCM services, similar to the requirement that only one practitioner can be paid for provision of CCM services. Finally, CMS proposed a number of criteria around the scope of CCM services which must be met in order to successfully bill and receive payment for providing CCM services. The comment period for this proposed regulation runs through September 8th, and CMS will likely publish the final rule in early November of this year.

CCM is an extremely useful and beneficial program for both providers and patients, and can help patients to more easily obtain medical care while allowing providers to receive reimbursement for time spent caring for patients, even when such care is provided from afar. The quickly changing and evolving requirements around CCM makes this both an exciting and challenging time to provide such services. Frier Levitt has represented a number of healthcare providers and companies providing CCM services and has advised these entities on how to comply with the myriad of laws and regulations governing CCM. If you are considering providing CCM services, please contact Frier Levitt today to discuss your interest and how Frier Levitt can help.

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