Medicare’s Best Program: Chronic Care Management

The Politics of Health Care

Medicare’s Best Program: Chronic Care Management

These are the five most important numbers for a Medicare patient and their physician- 99490.

In January 2015, the Chronic Care Management (CCM) program went into effect. Since then, the Center for Medicare and Medicaid Services (CMS) has been using Medicare CPT Code 99490 to reimburse physician practices who are providing monthly telehealth calls to patients with multiple chronic conditions.

The goal of CCM is to prevent chronic condition patients from re-entering the hospital or emergency department and injuring high health care costs via telehealth services.

How does this work? In order for physicians to bill for CCM, patient calls must have the following elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  • A comprehensive care plan established, implemented, revised, or monitored.

Using phone calls to interact with patients is not a new concept or standard of care, but with the emergency of CCM, CMS is now able to reimburse doctors for running a program (phone call patient interactions) they have previously done without reimbursement.

Increased access to physicians via telephone interactions will help patients address simple, untreated symptoms and prevent them from becoming potentially deadly and complex issues.

The Chronic Care Management (CCM) program requires that a dedicated medical professional is always available for patient requests, and supplemented by the monthly telehealth calls, ensure that no patient is left out in the proverbial cold. In no way does CCM replace necessary emergency services, but it provides opportunities to identify potential problems early. CCM will better inform treatment decisions and ensure the patient is on the proper path towards a healthy outcome.

There is still a ways to go to ensure all eligible patients are receiving CCM services. Managed Care Magazine reported CMS paid out approximately $12 million to participating doctors who received CCM on average of three times. Currently 35 million Medicare patients are eligible for CCM, this means that only a small portion of patients have been able to benefit since Jan 1, 2015.

For more information on CCM click here.

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