Home Health & Hospice Week

You can help your referral sources capture extra Medicare reimbursement they’re entitled to for many of your patients with a little education about new billing codes.

In the proposed 2014 Medicare Physician Fee Schedule, the Centers for Medicare & Medi-caid Services proposes "to establish separate payment for complex chronic care management services beginning in calendar year 2015," said CMS’s Kathy Bryant in a July 16 Open Door Forum for physicians. "We believe that this separate payment would recognize the critical non-face-to-face time and services of advanced primary care."

Because the newly proposed codes are not restricted to face-to-face services, the codes would include 24-hour per day, 7-days-per week access and continuity of care access with one specific member of the health care team. "For these services, we believe that complex chronic care services would apply to patients with two or more complex chronic conditions. By that we specified those expected to last at least 12 months or until the death of the patient, and those that would place the patient at significant risk of death, acute exacerbation or functional decline," CMS says in the rule.

Given the unique nature of the services, CMS has proposed that patients specifically consent to the services that will be administered throughout the year at the time of their annual wellness visit or welcome to Medicare exam. "The practitioner that would be providing the services would be required to document in the medical record that the complex chronic care management services were explained to the patient, offered to the patient, and the patient accepted," Bryant said. "There are provisions that would allow the patient to switch practitioners or revoke informed consent," but the vision is that the same practitioner will stay with the patient throughout the year.

Typically, CMS expects a patient’s annual wellness visit (AWV) provider to be the same person who provides the chronic care management services, the proposed rule states. But "for the less frequent situations when a beneficiary chooses a different practitioner to furnish the complex chronic care management from the practitioner who in the previous year furnished the AWV, the practitioner furnishing the complex chronic care management services would need to obtain a copy of the assessment and care plan developed between the beneficiary and the practitioner who furnished the AWV."

CMS plans to establish two "G" codes for the new chronic care services, the first of which will describe the initial visit, and the other to describe subsequent care. Each code will cover 90 days’ worth of services. Both physicians and non-physician practitioners would be eligible to perform the services. CMS’s proposed 2014 Physician Fee Sched-ule rule is at www.ofr.gov/OFRUpload/OFRData/ 2013-16547_PI.pdf.