In 2015, the new code 99490 was announced in Medicare to cater to patients with more than one chronic disease. It was a huge win because the role involved a lot of services that were previously deemed as unbillable time. Here is everything you need to know about how to bill chronic care management 99490 to Medicare.
What is Chronic Care Management
- Better communication opportunities
- Integral Care Planning
- Usage of accredited EHR technology (needed for billing CCM codes, but no longer necessary for CCM documentation or transitional care documentation)
- 24/7 Care continuity & access
- Managing Transitions in Treatment
- Comprehensive treatment management
- Coordination of treatment at home and in the Community
Patient Eligibility
Some types of chronic medical conditions are:
- Arthritis (rheumatoid and osteoarthritis)
- Asthma
- Autism spectrum disorders
- Atrial fibrillation
- Cardiovascular disease
- Alzheimer's disease and associated dementia
- Cancer
- Chronic obstructive lung disease
- Diabetes
- Depression
- Infectious diseases like HIV / AIDS
- Hypertension
Practitioner Eligibility
Physicians
Non-Physicians
- Clinical Nurse Specialists
- Certified Nurse-Midwives
- Nurse Practitioners
- Physician Assistants
Initiating Visit
Want to find out how we do it? Read on, or contact us for a quick chat.
Patient Agreement and Consent
- Availability of CCM services and cost-sharing opportunities applicable
- Only one provider can provide and be paid for CCM services during a calendar month
- Right to cancel CCM services at any time (effective at the end of the calendar month)
- Authorization should also be obtained for the electronic transmission of medical knowledge.
Steps in Billing CCM 99490
1. Identify Eligible Clients
You can use the Electronic Health Record to check for patients with more than two chronic conditions and run through reports sorted by the physician. Every practice will then review the report and exclude people who are not a good match for the CCM program
The patient must have two or more chronic conditions and also the following important elements:
- Chronic conditions intended to last for 12 months or until death.
- Conditions that put the patient at serious risk of death, acute exacerbation/decompensation, or decrease in function.
2. Inform and Enroll
3. Interact with Them and Activate the Service
- Provide a comprehensive evaluation of the patient's medical, functional, and psychosocial needs.
- Ensure that all appropriate preventive care services are provided on time.
- Share the full treatment plan with other physicians and providers as necessary.
Provide patients with a written or online copy of their detailed treatment plan. It is a low-cost way to send the care plan to the patient portal, thereby allowing all eligible patients (or their designated caregiver) to participate and become familiar with portal use.
Record the amount of time spent.
It’s possible to set up a program that will keep track of time spent on non-face-to-face services, including:
- Phone calls and email contact with patients.
- Arranging treatment with other doctors, hospitals, community resources, and caregivers (via the internet or other electronic correspondence)
- All medication reconciliation and prescription management