Chronic Care Management Services Presented by Noridian Part B Medicare Provider Outreach and Education April 2015
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 emailed 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 2015 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 http://www.noridianmedicare.com and the CMS website at http://www.cms.gov 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 2015 3
Helpful Acronyms Acronym Description CMA Certified Medical Assistant EHR EMR MLN Electronic Health Records Electronic Medical Records Medicare Learning Network April 2015 4
Agenda Overview Eligible Beneficiaries Eligible Providers Scope of Service Billing Noteworthy Information April 2015 5
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 2015 6
Overview April 2015 7
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 2015 8
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 2015 9
Chronic Conditions Alzheimer s disease and related dementia Arthritis Asthma Atrial fibrillation Autism spectrum disorders Cancer Chronic Obstructive Pulmonary Disease April 2015 10
Chronic Conditions2 Depression Diabetes Heart Failure Hypertension Ischemic Heart Disease Osteoporosis April 2015 11
Eligible Beneficiaries April 2015 12
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 2015 13
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 2015 14
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 2015 15
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 2015 16
Eligible Practitioners April 2015 17
Eligible Practitioners Physicians Certified Nurse Midwives Clinical Nurse Specialists Nurse Practitioners Physician Assistants April 2015 18
ACOs can not bill Not Eligible 2015 Staff in ACO may bill Federally Qualified Health Clinics (FQHC) Rural Health Clinics (RHC) April 2015 19
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 2015 20
Facility Question Q. Can both the facility fee and 99490 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 2015 21
Scope of Service April 2015 22
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 2015 23
Scope of Service2 Structured recording of demographics, problems, medications, medication allergies Creation of a structured clinical summary record, using certified EHR/EMR technology April 2015 24
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 email? Use HIPAA encrypted email or compliant work around April 2015 25
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 2015 26
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 2015 27
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 2015 28
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 2015 29
Comprehensive Care Plan3 Established Implemented Monitored Revised March 2015 30
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 http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms Calendar year 2015 May use EHR technology certified to 2011 or 2014 editions of certification criteria April 2015 31
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 2015 32
Billing April 2015 33
CCM Billing Only one practitioner bills/allowed monthly Non F2F services 99490 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 2015 34
Billing Requirements 99490 not billed during same month as 99495-99496 Transitional Care Management C0181/G0182 Home Health care supervision/hospice care supervision 90951-90970 End Stage Renal Disease 99091 Collection/interp of physiologic data April 2015 35
Not Allowed B (bundled) not separately covered 99487/99489 Complex Chronic Care Management 99497/99498 Advanced Care Planning See Federal Register (page 456) April 2015 36
Payment Information Payment for CCM service is separate under the Medicare fee schedule Medicare PFS Look Up tool http://www.cms.gov/medicare/medicare-feefor-service-payment/pfslookup April 2015 37
Questions and Answers
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 2015 39
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 2015 40
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 2015 41
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 2015 42
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 2015 43
Noteworthy Information
Resources MLN Catalog of Products http://www.cms.gov/outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/MLNCatalog.p df Chronic Conditions http://www.cms.gov/research-statistics-data- and-systems/statistics-trends-and- Reprots/Chronic-Conditions April 2015 45
Additional Resources Federal Register PFS final rule (CMS-1600-FC) at 78 FR 74414-74427, 2015 PFS final rule (CMS- 1612-FC) at 79 FR 67715-67730 Available CMS PFS web page http://www.cms.gov/medicare/medicare-feefor-service-payment/physicianfeesched/ PFS-Federal-Regulation-Notices.html April 2015 46
Provider Compliance Newsletter Quarterly Jan. 2015 http://www.cms.gov/outreach-and-education/medicare-learning-network- MLN/MLNProducts/downloads//medqtrlycomp-newsletter-icn909177.pdf April 2015 47
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 http://www.cms.gov/mlngeninfo MLN Matters Articles http://www.cms.gov/mlnmattersarticles MLN Products http://www.cms.gov/mlnproducts MLN Web Guides http://www.cms.gov/mlnedwebguide April 2015 48
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 https://med.noridianmedicare.com/web/jeb/education/training-events JF https://www.noridianmedicare.com/partb/train/workshops/index.html April 2015 49
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 emailed 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 2015 3
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