Speaker 1: Hi, everybody. Jennifer Blevins-Smith with Integral Clinic Solutions, and you're watching my YouTube channel, Navigating the Business of Medicine. Today I want to talk about chronic care management, or CCM, as often referred to in the clinical setting. Chronic care management is actually recognized by Medicare and Medicaid services, and it is reimbursed on the physician fee schedule. There's actual fees, reimbursement associated with the designated CPT codes for these services for providers to offer to patients. There are definitely some criteria that have to be met in order to be able to bill for these services. But the goal is... The goal is to help patients who have chronic conditions be healthier, to have someone checking on them, to try to catch any issues they might be experiencing early so that it doesn't get worse and it doesn't get to the point where they're not able to bounce back as fast or bounce back at all. It started being recognized in 2015 by Medicare, and it's just growing as the baby boomer population is getting older. And... Unfortunately, people are getting more unhealthy. This is definitely needed. In order for a patient to qualify to receive chronic care management services, they have to have at least two, if not more, chronic conditions that it is felt will last longer than 12 months or until their death, and that they could have a higher likelihood of an exacerbation or of it progressing, and the need to follow these patients closer, essentially. So... And oftentimes, chronic care services offered by providers and their clinical staff is not face-to-face. So, these are things that communication, activities, tasks that would take part outside of their normal scheduled office visits with their provider. The catch to this is only one provider per month can bill for chronic care services. So, if a primary care doctor and a cardiologist both share a patient, only one of them can offer the chronic care management services in a month and bill for that. They both can't do it. Sometimes that's a little bit hard to avoid, or if you don't know that somebody else is offering it, because this hasn't really been streamlined too much, where there's some kind of portal or platform in an insurance company that you can apply or designate yourself as the chronic care management provider or practice. And so, sometimes you might try to bill for these, and it comes back that it's already been billed by someone else, and you kind of have to eat those costs. But basically, it's for non-face-to-face, and it can include communication via telephone, via secure email or patient portals. It can be any type of administration tasks that you're needing to do to coordinate their care. So, if that's reviewing their medical records. And then making sure referrals get sent to specialists, or making sure that they're doing some kind of follow-up that they need to, anything like that. And you track your time throughout the month. So every month you track the time with these patients, and it has to be at least 20 minutes of time dedicated to this patient's specific care, and then you can bill the specific code. And then if you go over 20 minutes, then there's another CPT code you can add in addition to that. That shows for the additional time that you've spent, et cetera. And I'm just doing a very high-level, basic overview of this. If it's something that you want to bill in your office, I'm going to be putting some links of resources in the description for the video to help you start that research and make sure that you're following all of the billing guidelines. But basically, you have to make sure that your office has some kind of strict protocols, workflows. These patients to make sure that you're recording things accurately. You're recording the correct information that's required for CCM, that you're going to be able to bill it appropriately, et cetera. So definitely check those out. Like I said, high-level overview. The thing about chronic care management is you cannot bill chronic care management in the same month that you might try to bill transition care management, or TCM. So if a patient was hospitalized and they're going to be discharged and you follow up with that, you can't bill for both in the same month. So you can't do CCM in the same month as you do TCM. You kind of have to decide which one is best for you to be able to bill for. And there's all these other ins and outs that you need to look into. Right now, it's a little bit more flexible when it comes to telehealth and the requirements for face-to-face. So a patient has to have an initial CCM welcome to the office. They're going to have to have an initial CCM welcome to the office. They're going to have to have an initial CCM welcome to the office. They're going to have to have a CCM visit, essentially, with you. And it has to be face-to-face and it can be done during an annual wellness visit or something like that. But it needs to be documented that you talked about chronic care management, what it means to the patient, and they would need to be able to give you their authorization for you to offer CCM to them with the understanding that they could cancel their CCM subscription essentially at any time without penalty from you. So there are face-to-face requirements. You can do it annually after the initial one. Right now, you can do it via telehealth, it sounds like, because of the public health emergency, which we just found out last week, they did extend to April of 2023 right now. So that is good for people that are utilizing this flexibility in this situation. But you definitely want to look at that and have plans for when the PHE is lifted and they don't extend the flexibility of the telehealth for face-to-face, how your practice is going. So that's a good thing. Thank you. Again, patients who are going to receive chronic care management have to provide their consent either verbally or in writing, and it has to be documented in their medical record for that visit in which they provided their consent. And they need to understand that they can cancel it at any time and it won't affect any care that they receive from you or any other providers if they do cancel it. And you want to make sure that when you're tracking this. time that you have a best workflow in your practice to know when you need to submit for the billing. So let's say you've met the 20 minute requirement and you're only at day 20 of the month. Does your practice just want you to go ahead and submit the bill for that 20 minutes or are you going to wait until the 30th or 31st of the month depending on the how many days are in the month to submit that in case you provide additional time and then you can bill it out together because once it's submitted for the month you can't change it. So if you've done 20 minutes and then you send it out on the 20th of the month not thinking you're going to be talking or dealing with this patient anymore this month and you end up doing that you couldn't submit another claim with that additional time. To my understanding again I could be wrong but you'd want to look that up. I know a lot of practices wait until the last day of the month to run all of their CCM and send it out just to make sure they're capturing everything in one swoop and then it's easier to remember when things were submitted and how to track everything etc. But you need to find out exactly the billing requirements for your practice and how you want to do it and start implementing that every month. The thing about CCM is that there's only like four CPT codes that you bill and some of them can be used to bill for the month and some of them can be used to bill for the month. Some of them can be billed by your clinical staff and some of them have to be billed by a practitioner and that could be a mid-level even it doesn't have to be a doctor it could be you know some kind of nurse practitioner or physician assistant but there are certain codes that have to be billed by a provider versus your clinical staff and sometimes if you're using one of the codes you can't bill with the other code as well so there's kind of some odd little nuances in that so make sure you look up that as well and you have a strong understanding of that. Again this is another situation where if this is going to be something you want to adopt in your practice you might want to seriously consider consulting with a lawyer who specializes in health care law to make sure that you are doing everything the way that it stipulates in the CMS guidelines, Medicaid guidelines, etc. so that you don't get caught doing something that you shouldn't be even if you're unaware of it. It's your responsibility to do your due diligence. So I would definitely strongly consider and encourage that before you start. Also just to make sure that you're aware that Medicare and Medicaid do recognize this Medigap does help cover some of these costs for Medicare insured patients but commercial insurances are also covering this oftentimes and it's because Medicare covers it again that whole flow of you know commercial insurances follow what Medicare does it's been around long enough that most commercial payers are covering it but the caveat to that just like everything else is that patient cost shares could and probably will be applied so if patients are getting billed for CCM services and they haven't met their deductible or they have a co-insurance or a copay then those will probably apply they're not ignored. There's not any kind of exception to chronic care management in this regard so you definitely should consider that. when you get that consent from patients, you also have to let them know there is a strong possibility they could have a patient cost share every time it's billed out. If you have any questions or comments about this, please leave that in the comments below. Smash the thumbs up button if today's video is helpful and subscribe to my channel if you haven't already. Thanks so much, you guys. Take care of yourselves. We'll talk to you soon. Bye-bye. Bye-bye.