Payments Now Become Available
The new rule from the Centers for Medicare & Medicaid Services (CMS) allowing reimbursement for chronic care management (CCM) is a huge change that could create much more revenue for many physicians—enabling some practices to get paid for work they're already doing, and others to add services that will increase their revenue and improve patient care.
This means that making phone calls, helping patients fill out insurance forms, consulting with patients about medication over the phone, and taking calls from patients during evenings or weekends may all count toward billable activities, under the CCM code (99490) that went into effect on January 1, 2015.
Matt T. Rosenberg, MD
"The new CCM code allows payment for helping patients during non–face-to-face visits," says Matt T. Rosenberg, MD, family medicine, MidMichigan Health Center, Jackson, Michigan. "Instead of only getting paid when a patient comes in, physicians can provide care management by phone or other means of communication." Qualified activities include performing medication reconciliation and overseeing the patient's self-management of medications; ensuring receipt of all recommended preventive services; and monitoring the patient's condition (physical, mental, and social).
The potential payoff to physicians could be tremendous. Practices can earn $42.60 a month providing care for each patient qualified for CCM. With 500 qualified patients, you could earn an additional $255,600 annually. For practices with 1000 qualified patients, that could be $511,200 in additional annual revenue.
