Chronic Care Management: Revenue for Physicians, Improved Care for Patients

Chronic Care Management reduces the total cost of care for chronic disease patients while improving their overall health. In the 2015 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare & Medicaid Services (“Medicare”) acknowledged a provider’s ability to engage in non-traditional methods of assessing patients for chronic pain, effectively opening the door to payments for chronic care management (CCM).

CCM services are non-face-to-face medical care services that can be provided to qualified Medicare beneficiaries who experience two or more chronic conditions that are expected to last at least twelve months. Such services would include care coordination, medication management, and around-the-clock accessibility to patients and other care provides.

As contemplated by Medicare, providers may now provide CCM services to a beneficiary once a month by means of a phone consultation or electronically, thereby allowing for better coordination of care and regular follow up for patients with chronic conditions. Such services can be provided by physician extenders, such as nurse practitioners, to the extent permitted under the applicable Board regulations. CCM payments will reimburse providers for furnishing these non-face-to-face services to qualified beneficiaries on a monthly basis. For the first quarter of 2015, the national average reimbursement is roughly $40.00 per beneficiary per calendar month for 20 minutes of staff time. Medicare anticipates that a single busy practitioner may be able to generate over $200,000 in additional revenue, not including ancillary care that is generated by regular patient contact.

CCM is expected to have a tremendous effect on beneficiaries and physicians alike, allowing for patients with chronic diseases to seek and obtain medical care from their own homes with regular follow ups resulting in better management of chronic diseases and still yielding a reduction in staff time spent on the management of chronic care. In addition, the CCM payments have the potential to increase practice revenues arising out of medically necessary services for chronic care patients.

If you regularly treat patients with chronic illnesses, this may be a fantastic opportunity for your practice, whether you are a primary care physician or a specialist. Frier Levitt has developed standard operating procedures that may be used by physicians to implement CCM. Contact Frier Levitt today with questions or for help incorporating the use of CCM into your practice.