Chances are good that you're familiar by now with CPT code 99490, the new chronic care management (CCM) code that took effect Jan. 1 and allows providers to reconcile many services to Medicare patients for which they previously have gone unreimbursed. If you're anything like some early adopters, however, you may believe that the effort required to comply with the code outweighs the monetary benefits to your practice.
If that's you, rest assured: There are good monetary and intangible reasons to embrace 99490. By leveraging a few key strategies, you can greatly simplify the reporting process and begin realizing the financial benefits of the code more quickly than you might expect.
The Intent of CPT Code 99490
In a sense, the code is the Centers for Medicare and Medicaid Services' (CMS) way of "warming up" for the coming game day of a value-based reimbursement system. On average, a Medicare beneficiary with two or more chronic conditions will be under the care of five to seven providers. It is unreasonable to expect such a patient to coordinate information and treatment plans among all of those providers. The new code incentivizes one of these providers to play "quarterback" on this team of caregivers. More specifically, it requires providers to spend at least 20 minutes per month with Medicare patients who have at least two chronic conditions that are expected to last at least one year or that put the patient as risk of death or decline. In return, providers are reimbursed about $43 per month per patient. The goal is to increase efficiency of care while also increasing the revenues of the quarterbacking provider.
What's Keeping Providers from Making the Most of CPT Code 99490?
Recent press reports, however, have zeroed in on some physicians' concerns that the time required to gather and coordinate data with other physicians, as well as the patient, to form a single care plan outweighs the monetary benefit of making the claims. Other providers are anxious about introducing a new program that requires Medicare beneficiaries, many of whom are already financially stressed, to pay an additional $8.00 per month copay for chronic care services. Some providers even feel that they are selling services that their patients may already expect under their current program. Finally, some providers are simply skeptical of new Medicare initiatives; thus, they wait to hear colleagues' reviews before venturing into the water.
To be sure, these are all valid concerns. Still, the intent of CCM 99490 is to set the stage for a new chapter of value-based care, and there are significant benefits for providers who embrace CPT code 99490. For one, the new revenue is intended to offset the new workflows and incentivize providers to broaden their scope of care from the office setting to the patient setting, which can extend into the patients' homes and workplaces. All group practices with Medicare patient populations benefit from 99490, but small- and mid-size group practices stand to gain significantly. They are more vulnerable to the costs associated with the code's labor requirement, which calls for practices to hire one new licensed professional for every 250 – 270 patients. There are also intangible benefits: Patients with chronic disease, by nature, have more needs. If those needs can be met effectively, science has proven that chronic disease can be treated more efficiently.
Strategies to Implement CPT 99490
It's not as difficult to implement the code as one might think. By following key strategies, your practice can greatly simplify the reporting process and realize the benefits of the CCM code more quickly than you might expect.
First, conduct a comprehensive assessment of how your practice tracks patients and their care from other providers. This assessment should look at both technological capabilities and staff levels to ensure that processes are in place to enable interaction with patients and their caregivers outside of the point of care.
Second, use CCM to catalyze change of current sick-based appointment-driven workflow to a more coordinated system that interacts with the patients and other providers proactively. For example, having a comprehensive, up to date view of a patient's medical history, including everything from current medications to past and upcoming visits with other providers, can streamline the check in and triage process when patients come in for a visit. This is especially useful for chronic care patients, who typically visit multiple facilities between visits.
Third, reach out for expert help. The CPT code for chronic care management is so new, it is wise to consult an expert with proficiency in this area. Plus, efforts to comply can be subcontracted out. It's not much different from one provider learning a new medical procedure from, or referring it to, another provider with more experience. An expert will help guide you through the options in performing CCM in-house or using an outsourced vendor. In-house CCM can be a tall order, as there are several components to keep track of for meeting the code requirements. An outsourced vendor can do the heavy lifting for staff and provide the specialized support to help meet requirements. Medicare compliance should not be overlooked and an expert will be more familiar with the nuances of CCM.
Fourth, implement technology that complements your current infrastructure and can help you gather the information you need to meet the code. The right technology will take the burden out of the administrative hurdles associated with the requirements. Use the data collected from other providers, as well as your patients, to increase your confidence in treating your chronically ill patients. The increase in confidence of the whole staff acts as a positive feedback loop to embracing CCM. Moreover, when you have technology paired with services, it makes implementing the code even easier.
In a healthcare world that seems to be getting more complicated by the day, it's understandable that providers would be skeptical of yet another code. But CPT code 99490 represents an investment in patients and new workflows, the latter of which our healthcare system needs to improve and extend the quality of life for all. The new code has the potential not just to improve healthcare for patients with chronic conditions, but to enable providers to realize much-needed revenue streams.