Chronic Care Management Services. Presented by Noridian Part B Medicare Provider Outreach and Education April 2015

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1 Chronic Care Management Services Presented by Noridian Part B Medicare Provider Outreach and Education April 2015

2 Continuing Education Unit (CEU) When registering, add all additional attendees First and last names Attend entire workshop Q/A attendance optional Take short polling survey (mandatory for CPCs) Pops up After closing out of webinar CEU ed 3 days after presentation Earn 1.0 CEU today No password or index number needed All attendees use CEU certificate Certificate of Attendance no longer available April

3 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC (Noridian). It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and the Centers for Medicare & Medicaid Services (CMS). The most current edition of the information contained in this release can be found on the Noridian website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2015 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. April

4 Helpful Acronyms Acronym Description CMA Certified Medical Assistant EHR EMR MLN Electronic Health Records Electronic Medical Records Medicare Learning Network April

5 Agenda Overview Eligible Beneficiaries Eligible Providers Scope of Service Billing Noteworthy Information April

6 Objective The objective today is to give providers tools and information about the Chronic Care Management (CCM) program and how to bill and document appropriately April

7 Overview April

8 Overview Chronic Care Management Critical components of primary care Contributes to better health and care Reduced spending Non face to face care coordination services April

9 Overview 2 At least 20 minutes of clinical staff time May be aggregated from small increments Directed by physician/health professional Per calendar month Elements Two or more chronic conditions Expected to last at least 12 months Comprehensive care plan April

10 Chronic Conditions Alzheimer s disease and related dementia Arthritis Asthma Atrial fibrillation Autism spectrum disorders Cancer Chronic Obstructive Pulmonary Disease April

11 Chronic Conditions2 Depression Diabetes Heart Failure Hypertension Ischemic Heart Disease Osteoporosis April

12 Eligible Beneficiaries April

13 Eligible Beneficiary Population Beneficiaries with multiple (two or more) chronic conditions Expected to last at least 12 months Significant risk of death Acute exacerbation,decompensation or functional decline Should cover about 2/3 of all Medicare beneficiaries April

14 Beneficiary Permission Prior Before furnishing services, inform beneficiary with Written document of consent or decline No renewal needed unless provider changes Right to discontinue CCM verbally or in writing Only one practitioner bills to be paid Cost sharing details Coinsurance and deductible applies April

15 Beneficiary Agreement Informed consent signed in January, CCM not started until months later? No issue and can be billed anytime after all other requirements met April

16 Access of Care Patient has 24/7 access to provider care management services On call availability Continuity of care with a designated member of the care team Able to obtain routine appointment April

17 Eligible Practitioners April

18 Eligible Practitioners Physicians Certified Nurse Midwives Clinical Nurse Specialists Nurse Practitioners Physician Assistants April

19 ACOs can not bill Not Eligible 2015 Staff in ACO may bill Federally Qualified Health Clinics (FQHC) Rural Health Clinics (RHC) April

20 Supervision Exception under incident to rule Under general supervision; rather than direct Includes interdisciplinary and clinical teams E.g. Nurse may have initial contact outside of normal business hours April

21 Facility Question Q. Can both the facility fee and be billed by the physician who wrote the plan of care since we see both facility and a nonfacility payment amount? A. Either the outpatient hospital OR the practitioner may bill, but not both. April

22 Scope of Service April

23 Scope of Service Systematic assessment of health needs and receipt of preventive services Assessment of medical, functional and psychosocial needs Approach to ensure receipt of recommended preventive services Medication reconciliation Oversight of management of medication Including patient self-management April

24 Scope of Service2 Structured recording of demographics, problems, medications, medication allergies Creation of a structured clinical summary record, using certified EHR/EMR technology April

25 Scope of Service3 Electronic care plan Create/maintain comprehensive plan of care Electronic patient records/plan of care Make available 24/7 to all practitioners Share information with other practitioners Must be electronic; not fax If the receiving provider cannot accept or receive electronic HIPAA compliant ? Use HIPAA encrypted or compliant work around April

26 Scope of Service4 Communicates with other treating professionals for management care transitions Between health care providers and settings Include referrals to other providers Providing follow-up after an emergency department visit and after discharges from hospitals, skilled nursing facilities or other health care facilities April

27 Scope of Service5 Coordination with home and communitybased clinical service providers As appropriate Communication to and from these providers Enhance communication opportunities for patient and caregivers April

28 Comprehensive Care Plan Problem list Expected outcome and prognosis Measurable treatment goals Symptom management Planned interventions and identification of the individuals responsible for each intervention April

29 Comprehensive Care Plan2 Medication management Community/social services ordered Description on how services of agencies and specialists outside the practice will be directed/coordinated Schedule for periodic review and any revision of the care plan April

30 Comprehensive Care Plan3 Established Implemented Monitored Revised March

31 Electronic Technology Certified EHR technology requirements Version acceptable under EHR Incentive December 31 st of year preceding payment year Time spent setting up electronic care plan counts More information available Guidance/Legislation/EHRIncentivePrograms Calendar year 2015 May use EHR technology certified to 2011 or 2014 editions of certification criteria April

32 Miscellaneous Tips CMA entering information in EHR counts Nurse charting time counts Pharmacist employed counts for medication management only Contract providers okay if meet rules Make sure documentation includes time breakdown No end date for CCM may last years April

33 Billing April

34 CCM Billing Only one practitioner bills/allowed monthly Non F2F services Reimburse approx. $40 monthly 20 minutes or more; per 30 calendar days Aggregated/documented by different clinicians Deductible/Coinsurance apply Bill any date within that month First, last or middle March

35 Billing Requirements not billed during same month as Transitional Care Management C0181/G0182 Home Health care supervision/hospice care supervision End Stage Renal Disease Collection/interp of physiologic data April

36 Not Allowed B (bundled) not separately covered 99487/99489 Complex Chronic Care Management 99497/99498 Advanced Care Planning See Federal Register (page 456) April

37 Payment Information Payment for CCM service is separate under the Medicare fee schedule Medicare PFS Look Up tool April

38 Questions and Answers

39 Questions and Answers Q1.Can the charting time by a nurse be counted as time, counted toward the CCM? A1. An RN is certainly clinical staff, and if they are doing chart documentation related to the CCM services, that time should certainly be counted. April

40 Question and Answers Q2.Is it valid to get the conformed consent but not have enough minutes to start billing for CCM in that month? Can you start billing the next month if you meet minutes required? A2.You may obtain the informed consent some months before the first time you bill and start billing when the 20 minutes has been met in a month. April

41 Question and Answers Q3.Are pharmacists included in the non exhaustive list of clinical staff. A3. If a pharmacist is employed by your clinic and is part of managing medications that time spent by the pharmacist could be included in count towards the minimum 20 minutes for the practice to bill. April

42 Questions and Answers Q4.Does consent form have to be renewed yearly? A4.The consent does not need to be repeated unless the patient changes practices and someone else is going to bill. April

43 Questions and Answers Q5.Does generating a care plan in the EMR satisfy the requirements that the patient was given a copy, or does there need to be a separate documentation that the patient received a copy? A5. A copy must be given to the beneficiary either a written or an electronic copy, but you have to document in your Certified EHR that you gave them the copy. April

44 Noteworthy Information

45 Resources MLN Catalog of Products Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/MLNCatalog.p df Chronic Conditions and-systems/statistics-trends-and- Reprots/Chronic-Conditions April

46 Additional Resources Federal Register PFS final rule (CMS-1600-FC) at 78 FR , 2015 PFS final rule (CMS FC) at 79 FR Available CMS PFS web page PFS-Federal-Regulation-Notices.html April

47 Provider Compliance Newsletter Quarterly Jan MLN/MLNProducts/downloads//medqtrlycomp-newsletter-icn pdf April

48 CMS Educational Materials MLN products downloadable Free of charge/free shipping Brochures Fact sheets Quick reference charts Web-based training MLN dedicated web pages MLN General Information MLN Matters Articles MLN Products MLN Web Guides April

49 Part B Webinars Date Time (CT) Webinar Title 4/10/15 1:00 PM Chronic Care Management Services 4/14/15 1:00 PM Telehealth Services 4/15/15 1:00 PM Medicare Secondary Payer (MSP) 4/16/15 1:00 PM Quarterly Release 4/21/15 1:00 PM Critical Care Q/A 4/22/15 1:00 PM Modifier 59 Clarification Register Now! JE JF April

50 CEU Reminder: When registering, add additional attendees First and last names Attend entire workshop Q/A attendance optional Take short polling survey (mandatory for CPCs) Pops up after closing out of webinar CEU ed 3 days after presentation Earn 1.0 CEU today No password or index number needed All attendees use CEU certificate Certificate of Attendance no longer available April

51 51

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