CMS Reducing Administrative Burden and improving Payment Accuracy for Chronic Care Management (CCM) Services in CY2017 Physician Fee Schedule Final Rule

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CMS release G0506, 99487 Complex Chronic Care Management (CCM) services Code and 99489 Add on CCM Code. RHC and FQHC supervision requirements are eased. Written consent not required in the CY2017 Physician Fee Schedule Final Rule

SPAC Chronic Care Management Cloud Portals

SPAC Chronic Care Management Cloud Portals

Our physician practices report that our Case Managers proactively help reduce ER visits, Hospital Visits over the weekend by staying on top of the patient symptoms and medications, says Git Patel, CEO of SPAC International.

CMS Published the CY2017 Physician Fee Schedule Final Rule on November 15, 2016 that reduces the administrative burden for Chronic Care Management (CCM) services. To date, only 513,000 patients received CCM services an average of four times, totaling $93 million in total payments since 99490 was released in January of 2015. SPAC International Chronic Care Management cloud portals are ONC HIT certified and help keep the patient care plans inter-operable among providers.

SPAC FDA approved Chronic Care Management Mobile Apps and Medication Therapy Monitoring APPs help patients remain actively engaged with their providers with the help of case managers who help with the care co-ordination of these patients. "SPAC's Chronic Care Management program’s benefits were apparent within two weeks. For example, a complex patient avoided an unnecessary ER visit by speaking to SPAC Case Manager on a weekend, said Kayla Austin, one of our practice managers". Section 103 of MACRA, requires CMS to assess and report to Congress (no later than December 31, 2017) on access to CCM services by under served populations and to conduct an outreach/education campaign. Based on this,CMS finalized several changes in the payment rules for CCM Services in the final rule for the CY2017 Physician Fee Schedule to reduce the burden of Chronic Care management.

a.)Initiating Visit – Required only for new patients or patients not seen within one year instead of all beneficiaries receiving CCM Services
Add on code:
G0506 – Comprehensive assessment of and care planning by the physician for patients requiring CCM services This is Add-on code, list separately in addition to primary service to be billed once per patient.(payment of about $63.68)

b.) 24/7 Access to Care, Continuity of Care, Care Plan and Managing Transitions:
After hours access to electronic care plan not required and care plan can be faxed.

Conitnuity of Care requires ability to obtain successive appointments with a designated member of the care team.
Required to create and exchange/transmit continuity of care documents timely with other practitioners and providers.

c.) Beneficiary Receipt of Care Plan:
Simplified to copy of care plan be given to patient or care giver regardless of a specific format.

d.) Beneficiary Consent
Written consent is optional but it has to be recorded in the EMR that the beneficiary accepted or declined CCM services that were explained to him/her.

e.) Documentation:
No longer required the use of a qualifying certified EHR to document communication but documentation still required in the medical record of consent and of communication to and from home and community based providers regarding patient's psychosocial needs and functional deficits.

f.) The final CY 2017 service elements for CCM are summarized in table 11 as attached or on page 311 of the final rule.

Complex CCM Code and addon code:

99487 – (pays about $92.66) Complex Chronic Care Management Services. Requires same service elements as CCM but requires 60 minutes of clinical staff time per calendar month

99489 – (pays about $46.87) Each additional 30 minutes of clinical staff time per calendar month.

FQHCs and RHC can now fully participate in CCM
Supervision rules eased - CMS has removed the direct supervision requirements allowing FQHCs and RHC to outsource with CCM contractors like SPAC International to deliver a turn-key solution. They have also eased the CCM provision requirements.
[RHC and FQHC final rule Pages 325 to 333 and 760 to 764

Prolonged non face Face E/M codes:

CPT 99358 – Prolonged E/M service before and/or after direct patient care, first 60 minutes paid at about $113.41

CPT 99359 – Prolonged E/M service before and/or after direct patient care, each additional 30 minutes (listed separately in addition to CPT 99358) paid at about $54.38.

BHI Codes for Psychiatric Collaborative Care Model (CoCM)

G0502 – Initial psychiatric collaborative care management, first 70 minutes in the first
calendar month. (paid at about $135.95)

G0503 – Subsequent psychiatric collaborative care management, first 60 minutes in a
subsequent month, paid at about $119.85

G0504 – Initial or subsequent psychiatric collaborative care management, each
additional 30 minutes in a calendar month(paid at about $59.74)

G0507 – Care management services for behavioral health conditions, at least 20
minutes of clinical staff time, per calendar month. (paid at about $42.21)

About: SPAC International
Sargas Pharmaceutical Adherence and Compliance (SPAC) International"s Vision is to create a seamless connection between the physicians, patients, insurance companies, hospitals, pharmacies and pharmaceutical companies such that the patient gets the proactive clinical care that everyone wants, when they want it by utilizing the latest communication technologies, patent pending FDA approved mobile Medication Therapy (MTM) Monitoring applications, and HIPAA compliant ONCHIT certified Chronic Care Management cloud portals. This Automation along with our case managers helps make care coordination, chronic care management and real time symptom management feasible, scalable and sustainable.

SPAC International’s Technology is at the forefront of Federal Health IT Strategic Plan 2015-2020 because it is interoperable among providers and can collect, share, and use health data to improve health, healthcare, and reduce costs. SPAC has several hundred physicians under contract nationwide that have to several thousand medicare beneficiaries who are monitored by SPAC case managers.

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Gitesh Patel

Git Patel
since: 03/2015
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Sargas Pharmaceutical Adherence & Compliance - SPAC International
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