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Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue
Chronic Care Management Reimbursement Compliance:  Physician Requirements for Value-Based Revenue
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Beyond providing added revenue, billing via Medicare Chronic Care Management (CCM) CPT codes helps to bridge physician practices to value-based care delivery models like the accountable care organization (ACO) or patient-centered medical home (PCMH).

Use of the CCM codes is also an opportunity to launch or enhance a chronic care management program. According to 2015 market data, nearly half of responding healthcare organizations lack a formal chronic care management structure, leaving critical reimbursement dollars on the table.

However, practices poised to bill under CCM codes must contend with vague guidance from CMS in certain areas and conflicting interpretations from outside sources on CCM implementation.

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements.

In this 25-page resource, attorneys Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, drill down into chronic care management requirements outlined in the 2015 Medicare Physician Fee Schedule.

They also describe CCM's business opportunities for billing providers, physician practices and vendors as well as the codes' potential to transition practices to an ACO, PCMH or other quality-based care model.

In Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue, Dr. Rudolf and Ms. Liffrig cover the following essentials of CCM:

  • Eligibility requirements for patients and the challenge of defining chronic conditions;
  • Requirements for eligible healthcare professionals, including who may bill and who may provide CCM services;
  • Clinical staff guidelines and supervision requirements;
  • The five steps of patient consent, and strategies for handling refusals and retroactive consent;
  • Status of Complex Care Management Code;
  • Practices' use of CCM to create infrastructure for emerging care delivery models and distinguish themselves in the healthcare marketplace;
  • Requirements for care coordination services, with six examples of care coordination services;
  • Seven gray areas where CMS must provide additional guidance;
  • Strategies for coping with conflicting CCM guidance;
and much more, including responses to a host of FAQs on CCM billing and implementation.

Table of Contents

  • CCM Reimbursement Compliance: Overcoming Obstacles and Meeting Requirements
    • CCM Background
    • Patient Eligibility
    • Eligible Professionals
    • General Supervision and Employment Arrangements
    • Patient Consent: Real-Time and Retroactive
    • Care Coordination Services
    • Documentation of Clinical Staff Activities
    • Practice Capabilities
    • The Care Plan: Providing Access
    • EHR Use and Privacy Concerns
    • Risks and Knowledge Gaps
  • Q&A: Ask the Experts
    • Billing Barriers
    • Care Plan and Case Management EHR
    • Sources for CCM Guidance
    • Patient Consent and Payments
    • Future Eligible CCM Professionals
    • Future CMS Updates on CCM
    • Guidance on Monthly Patient Supervision
    • Patient Attribution for CCM
    • Home Health Contracts for CCM
    • FQHCs and CCM
    • Timeline for Complex Chronic Care Management
    • Patient Access to Care Plan
    • Current CCM Billing
  • Glossary
  • For More Information
  • About the Contributors
Publication Date: April 2015
Number of Pages: 25
ISBN 10: 1-941329-68-3 (Print version); 1-941329-69-1 (PDF version)
ISBN 13: 978-1-941329-68-9 (Print version); 978-1-941329-69-6 (PDF version)
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Physician Reimbursement in 2016: Workflow Optimization for Chronic Care Management and Advance Care Planning, a 45 minute-webinar on January 26, 2016, now available for replay
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