Home Health & Hospice Week

Watch for chronic care codes coming.

With face-to-face and other regulatory burdens making it more work to refer patients to home care, it would be nice for physicians treating home care patients to earn a little more reimbursement for them. Soon they can under the Final 2014 Medicare Physician Fee Schedule published in the Dec. 10 Federal Register.

As outlined in the proposed rule (see Eli’s HCW, Vol. XXII, No. 27), the final rule confirms physicians can see bonuses in 2015 if they care for patients with multiple chronic conditions. These bonuses will reflect payments outside of the E/M services for face-to-face visits that docs already collect for these patients.

"Health care is changing, and part of delivery system reform is recognizing this and making sure payment systems account for these changes," Centers for Medicare & Medicaid Services Principal Deputy Administrator Jonathan Blum says in a statement. "We believe that successful efforts to improve chronic care management for these patients could improve the quality of care while simultaneously decreasing costs, through reductions in hospitalizations, use of post-acute care services, and emergency department visits."

CMS will establish two "G" codes for the new chronic care services, but the specific code numbers have not been identified yet. The codes will represent "complex chronic care management services furnished to patients with multiple (two or more) complex chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acut exacerbation/decompensation, or functional de-cline," CMS says in the rule. The codes will be:

• GXXX1, initial services; one or more hours; initial 90 days; and
• GXXX2, subsequent services; one or more hours; subsequent 90 days.

The second code (Gxxx2) will be limited to the 90-day periods when the patient’s medical needs require "substantial revision of the care plan," CMS says in the rule.

Note: Point your referral sources to the final rule at www.federalregister.gov/articles/2013/12/10 — scroll down to the CMS entry.