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Chronic conditions such as diabetes, hypertension, arthritis, cancer, COPD, and Alzheimer’s affect more than three-quarters of Americans and are especially prevalent among the elderly. These long-term illnesses account for 86% of healthcare costs. To manage these chronic conditions and help control costs, the Centers for Medicare & Medicaid Services (CMS) established a process for chronic care management (CCM) to help improve patients’ lives and reimburse healthcare providers for their efforts.

Research has proven that patients living with chronic diseases, who are continuously monitored, often live longer, have fewer acute episodic health events, better medication management plans, and significantly less health-related expenses. With that in mind, CMS introduced new avenues for the reimbursement of remote patient monitoring (RPM) services, which has the potential for better patient outcomes, especially in chronically ill patients. Not to mention a boost to your practice’s bottom line. 

What Is Chronic Care Management?

Chronic care management allows qualifying patients suffering from two or more chronic conditions to receive extra care and support every month. This includes over twenty minutes of non-face-to-face care services, as well as comprehensive patient-centered care planning, and 24/7 virtual access to a variety of qualified healthcare professionals.

CCM also includes services outside of the hospital, such as care coordination via messaging platforms, continuous physiologic monitoring, accessibility, and medication management.



What Are The Benefits Of Putting Chronic Care Remote Patient Monitoring Strategies Into Practice?

By putting a CCM plan through an RPM strategy into practice, a higher level of healthcare management can be achieved. This includes a range of value-based cases, such as overall improved population health, increased patient satisfaction, cost reduction, as well as an improved healthcare provider experience. Of course, it’s always good to be reimbursed for the services you are already providing.

Participation in the CCM program fulfills MIPS requirements, which can improve your practice’s ability to meet incentive requirements and avoid penalties. With the right tools in place, both physicians and patients suffering from chronic illnesses can benefit from chronic care remote patient monitoring.


Why Isn’t CCM Widely Adopted By Providers?

Successful implementation of the CCM program alone can result in reimbursement of minimum of $42+ per patient, per month. Despite this, CCM is not widely adopted by providers due to compliance concerns, a lack of awareness and understanding, the tedious billing process, time documentation issues, and inefficient administrative works. 

In other words, CCM is a bit confusing at first. Many providers are simply not utilizing this service because they’re not quite familiar with how it works. 


How Can You Bill Chronic Care Patient Monitoring Codes In Your Practice?


To bill CMS under the relevant CPT codes, your practice must meet or provide the following criteria:

  • You must be using a certified EHR 

  • Patients must have 24/7 access to clinical staff for urgent care needs

  • Continuous care for all chronic conditions, including medication reconciliation and regular assessment of the patient’s medical needs via access to an established care team

  • A patient consent form is mandatory before proceeding with virtual consultations and reimbursements

  • A patient-centered care plan should be available electronically to the patient, provider, and care team

  • You must track and record a minimum of 20 minutes of non-face-to-face CCM services per month

  • For billing, the DOS must be the day when the 20 minutes of non-face-to-face time is reached


Who Is Eligible To Bill For CCM?

  • Primary care providers, specialists, advanced practice registered nurses, physician’s assistants, clinical nurse specialists, and certified nurse-midwives are all eligible to bill Medicare under this new CCM payment model 

  • Non-physicians and limited-license practitioners such as clinical psychologists are not eligible for CCM reimbursement

  • Non-FQHCs and RHCs can participate in the 20 minutes of non-face-to-face interaction prior to general physician supervision

  • A clinically licensed staff member, such as a medical assistant (MA), can provide CCM services as long as they are an employee of the practice


What Are The CPT Codes Used In Chronic Care Remote Patient Monitoring?




What Are the New Changes Implemented In The CMS Reimbursement Rules?

  • The CPT code 99457 is billed based on a calendar month, and not per 30-day period for easier tracking of claims submissions

  • Compared with the 30 minutes of time required for CPT 99091, CPT 99457 only requires 20 minutes of interactive communication with the patient and/or caregiver

  • If the patient is new or has not visited the clinic in over a year, a direct visit is required before opting for the virtual one

  • Both CPT 99457 and CPT 99490 can be billed in the same month, but the time duration will be 40 minutes


How Can CCM Boost Your Practice’s Revenue?

  • Providers can receive additional reimbursements with a minimum of $186 per patient per month – with a possible $228 per chronic patient per month, by increasing time duration and billing both CCM specific CPT codes and RPM CPT code 99457 in the same month. 

  • For a provider that services a panel of 1,500 patients, where 21.8% of the panel belongs to Medicare, which comes to 327 patients, around 68.6% of their Medicare patients will have 2 or more chronic illnesses. This comes to 224 Medicare patients who are chronically ill. Even if 50% of the chronically ill Medicare patients utilize chronic care remote patient monitoring services, the average monthly payment per patient goes up to $186. This equates to a potential minimum of $249,984.00 in additional practice revenue per year. 

  • Not all the Medicare patients with multiple chronic illnesses will opt for CCM services. However, it is expected that others will follow because many patients under the age of 65 can benefit from CCM services.


Does this sound interesting to you?  Is this something you would like to implement in your own practice?


Get started and explore Chronic Care Management (CCM) solutions for your practice, as well as how you can implement to boost your revenue.

How Can CCM Boost Your Practice’s Revenue?

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