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

Policy & Regulation News

Medicare Pushing Coordinated Care Efforts for Chronic Conditions

By Ryan Mcaskill

With two new fees, Medicare is adding incentives for doctors to better coordinate care for patients with chronic conditions.

- Back in November, the Department of Health and Human Services (HHS) released the 2015 final physician fee schedule rule. One piece of the rule that was overlooked, but could have a major impact on the healthcare revenue cycle, is the inclusion of a code for chronic care management.

This is all part of an increased effort to improve healthcare services. Previously, Medicare has made strides account for other kinds of non-face-to-face services in recent years. Last year, Medicare began paying physicians for “transitional care management” for patients that have been transitioned out of the hospital setting.

The new code – 99490 – allows providers to bill for time spent developing a plan of care and managing care for patients with two or more chronic, life-threatening diseases. It pays providers $42.60 for 20 minutes of staff time and can be billed once per month per patient. There are a number of requirements that providers need to follow in order to ensure proper reimbursement.

Raemarie Jimenez, CPC, CPB, vice president for member and certification development with the American Academy of Professional Coders, told Medical Economics that this decision is part of a long-term government plan to encourage a greater focus on the value of care and patient outcomes, rather than focusing on the volume of services provided.

From the provider’s perspective, it takes a lot of work to be proactive and get their patients the different kinds of care they need to stay healthy. &ldquote;This gives them a reportable way to do that,” says Jimenez.

An article from the Associated Press, added that this is part of an increased effort to improve coordinated care. Currently, two-thirds of Medicare beneficiaries have at least two chronic conditions including diabetes, heart disease or kidney disease. Care for these issues can be segmented and include visits to multiple doctors and specialists for each aliment.

This makes it increasingly difficult to oversee the overall health of a patient and ensuring that treatments do not over interact poorly with each other, tests like x-rays are not repeated and an number of other things that could be overlooked.

"We all need care coordination. Medicare patients need it more than ever," Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services, told the Associated Press. "We're hoping to spur change, getting physicians to be much more willing to spend time working on the needs of these patients without necessitating the patient to come into the office."

A new $40 fee that is paid to primary care doctors will help coordinate care. To qualify, physicians must create a care plan for qualified patients and spend time each month on activities that will coordinate care with other providers and monitor medications. Patients must also have a way to reach providers 24-hours a day in order to access health records.



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