Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Reimbursement News

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

A new survey finds primary care physicians are interested in chronic care management, but many do not know the Medicare reimbursement code for some of the services.

Medicare reimbursement and chronic care management

Source: Thinkstock

By Jacqueline LaPointe

- CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is lacking.

According to a Regina Corso Consulting survey, commissioned by Quest Diagnostics, only 51 percent of primary care physicians knew Medicare would reimburse them under the Physician Fee Schedule for certain chronic care management services.

While primary care physicians may not be aware of the codes, the majority of them still wish to implement the services. About 84 percent of the providers said chronic care management services would improve care quality at their practice, the survey of over 800 primary care physicians and Medicare patients found.

Another 86 percent of the surveyed providers also said chronic care management would help their practice score higher on quality measure for value-based care models.

“Two in three Medicare patients have multiple chronic conditions that require ongoing medical attention and substantial resources from the healthcare system,” stated Jeffrey Dlott, MD, Medical Director for Chronic Care Management, a part of the Extended Care offerings at Quest Diagnostics. “Our survey findings show that PCPs desperately want to deliver high-quality care, but they feel they are failing their patients with the most complex care needs.”

CMS introduced the Medicare reimbursement program for chronic care management in 2015. The program’s code covers non-face-to-care care provided to patients with multiple chronic conditions. They allow providers to get paid for creating and updating care plans, reviewing results, communicating with other providers outside of their practice, regularly adjusting treatments, and other non-face-to-face services.

While the code aims to provide sufficient compensation to cover comprehensive chronic disease management, use of the program is lacking.

Just one in four primary care physicians has implemented the chronic care management program in their practices.

Forty-three percent of the providers said they have yet to implement the program because of the complexity of coding. Another 37 percent said the amount of paperwork associated with chronic care management prevented them from implementing the service.

Medicare reimbursement also contributed to a lack of chronic care management implementation, the survey showed. One-quarter of primary care physicians failed to use the chronic care management code because the payments were too low.

Insufficient reimbursement for the code has been a persistent issue for CMS. The original rate for the chronic care management code was $42.71 per month, but providers complained that the amount was not enough to cover the resources needed to furnish the comprehensive services and complete the necessary documentation.

Facing these challenges, providers failed to use the chronic care management code, the Urban Institute’s Health Policy Center recently reported. CMS projects about 26.5 million Medicare fee-for-service beneficiaries to qualify for use of the code.

Yet, the federal agency only received claims with the code for just 500,000 beneficiaries in November 2016.

CMS addressed provider challenges with chronic care management code adoption in 2017. The federal agency simplified service requirements for the codes and lessened the administrative burden by creating new codes and add-on billing codes.

The average reimbursement rate for the codes also increased to about $62 per month.

Despite the recent modifications to the chronic care management codes, provider awareness of the Medicare reimbursement program is still lacking.

“Physicians are open to adopting CCM [chronic care management], but it has to be easier to implement and a trusted extension to one’s practice,” stated Katherine A. Evans, DNP, FNP-C, GNP-BC, ACHPN, FAANP, immediate past president of the Gerontological Advanced Practice Nurses Association (GAPNA). 

Ensuring the chronic care management codes align with provider practices could help Medicare to reduce healthcare costs. CMS reported in 2017 that the federal agency reimbursed about $52 million in chronic care management payments and produced net savings of $36 million.

Less use of inpatient and outpatient care using the non-face-to-face codes drove the savings, CMS reported.

In light of the reduced costs, CMS launched a national campaign to encourage provider use of the codes in 2017.


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