Medicare Compliance & Reimbursement

Don’t let Medicare’s red tape keep your physicians from claiming their chronic care management pay. 

Your physician referral sources may be happy about Medicare’s new payment of $40.39 per month for chronic care management, but you should remind them that the Centers for Medicare & Medicaid Services (CMS) will require them to meet specific rules before they collect.

“In 2015 we will be paying for chronic care management services,” CMS’s Kathy Bryant said during a Nov. 12 CMS Open Door Forum for physicians. “We wanted to recognize the critical non-face-to-face time and the services of advanced primary care,” she said.

Reminder: Patients with two or more chronic conditions can benefit from the service, which is billable using code 94990. But educate your physicians on the fact that they must first meet the following requirements outlined by Bryant:

1) They must provide 20 minutes or more of the service per calendar month. “This is not a per beneficiary per month payment,” Bryant said. “It is only paid in the calendar month in which a practitioner or their offices provide 20 minutes’ worth of service.”

2) Co-insurance charges apply, which means that they must inform the beneficiary that they plan to bill for it.

3) They must get a “written agreement from the beneficiary” that they agree to receive the services.

4) They have to give the beneficiary a copy of the CCM plan of care.

5) They should report 94990 only if no other provider is billing for the service during the same month. “Only one practitioner can bill for this service at a time,” Bryant stressed.

6) For services incident to the billing practitioner, general supervision is allowable rather than direct supervision “if the staff providing from the service are clinical staff,” Bryant said.