In 2015, CMS began reimbursing primary care physicians $42 per patient, per month on average, for delivering non-face-to-face care to Medicare patients with two or more chronic conditions. Chronic Care Management (CCM).
To meet the requirements for CCM reimbursement however, you'd need to invest time and money to run background checks, hire and train a certified medical assistant (CMA), create internal systems and protocols for monthly calls to patients, and then document the calls in an EHR… it's a lot.
But...no worries, did you know you can outsource the entire process, risk, CMS compliancy requirements and all? PMR's revolutionary CCM solution can help your practice get compliant & setup to take advantage of this new billing code in days, not weeks, or months.
To prepare your practice for these changes, we developed an audit-proof system that ensures your compliance with all CMS guidelines and optimizes new revenue opportunities.
We’ll help you navigate the complex challenges of Chronic Care Management by bringing greater accuracy, efficiency and clarity into your CCM efforts. Our industry leading software is simple and easy-to-use. It helps you identify, qualify and manage your patient database with speed and accuracy so you can get more from your CCM program.
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* The CCW includes 22 specified chronic conditions. This is not an exclusive list of chronic conditions, so CMS may recognize other conditions for purposes of providing CCM as well.
Who is an eligible beneficiary?
A beneficiary is eligible to receive CCM if he or she has been diagnosed with two or more chronic conditions expected to persist at least 12 months (or until death) that place the individual a significant risk of death, acute exacerbation/decompensation, or functional decline.
What type of consent is required?
A provider cannot bill for CCM unless and until the provider secures the beneficiary’s written consent. The PMR CCM maintains a signed CCM patient agreement in the patient’s medical record.
What type of service qualifies for reimbursement?
CMS specifies that the code must be billed for “non-facetime follow-up care outside the office” each month. There must be at least 20 minutes of non-face-time follow-up care outside the office each month. This includes charting and scheduling for virtual office visits the PRM CCM integrates patient scheduling for virtual visits; charting their encounter and prescribing are the same workflows as the ones you use to record a standard office visit.
Which providers can bill Medicare for CCM?
Physicians (regardless of specialty), Advanced practice registered nurses, Physician assistants, Clinical nurse specialists, Certified nurse midwives
What level of professional can bill for the 20 minutes of non-face-to-face time?
Eligible practitioners must act within their State licensure, scope of practice and Medicare statutory benefit. Services provided directly by an appropriate physician or non-physician practitioner, or other clinical staff “incident to” the billing physician practitioner, counts toward the minimum service time required to bill for CCM services per calendar month. Non-clinical staff time cannot be counted towards the minimum CCM monthly services; however, CCM services may be recorded by non-clinical staff.
Which providers are not eligible to bill Medicare for CCM?
Other non-physician practitioners and limited-license practitioners (e.g., clinical psychologists, social workers)
What additional costs are involved for the patient?
Patients are required to pay a co-pay under this program. About 90% of your patients may not have to pay out of pocket for the co-pay. Only one in 10 beneficiaries relies solely on the Medicare program for health care coverage. The rest have some form of supplemental coverage to help with medical expenses. office visit.
PMR's I partnered with one of the nations largest healthcare service providers solely dedicated to supporting the Medicare CCM reimbursement process. Our new Chronic Care Coordination Center is staffed by certified medical assistants, RNs and MDs.
This seamless extension of your practice is here for you and your patients 24/7, supporting continuity of care. To ensure you are compensated, we provide an all-inclusive method for tracking and billing for the new CCM code.
"Earn An Average of $42 per patient, per month!"