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CMS increased the reimbursement rate for CCM and released the new CPT codes 2023 for beneficial billing and reimbursements for healthcare professionals.
You’re probably aware of this if you work in the medical field. However, Do you understand the rates and guidelines for Medicare chronic care management 2023?
If not, this blog will help you clear your doubts and provide you with the latest and most valuable information about the CCM and how you can increase your practice efficiency by successfully meeting CMS guidelines.
Chronic care management is the care service administration that provides coverage to patients with two or more chronic conditions. CCM is comprehensive care provided outside of a clinic or office setting.
CCM allows healthcare professionals to be reimbursed for services and other resources provided to patients through care planning, remote communication, medication management, and care coordination between providers.
CCM includes face-to-face patient visits, telephone, and email conversations, review of medical records and results, and educating and supporting health care services. The patient care team bills for the time spent managing patients’ conditions.
The Current Procedural Terminology (CPT) codes provide the uniform language for the medical services and procedures. These codes are used for billing for the health care services provided to the patient; encapsulating the particular services into one code makes it easy to understand by everyone from healthcare professionals to insurance companies as well.
CPT codes provide a universal terminology used to report medical services for monitoring, consulting, and providing healthcare by clinical staff, physicians, practitioners, and other healthcare providers. The services include processing claims, developing care plans, supporting calls and messages, and other healthcare documentation.
After the first visit and the consent of the patient to undertake the CCM services, the CPT codes are used for monthly bills. CMS released medicare chronic care management CPT codes 2023, enforced from 1 January ’22.
Every code reflects different amounts of time and services, categorized into two parameters according to the health conditions. Let’s look at the CMS chronic care management 2023 codes:
Also Read: Remote patient monitoring companies for hospitals
Chronic care management programs begin with the first face-to-face meeting between the health care professional and the patient. Qualified professionals include physicians, certified clinical nurse specialists, practitioners, and physician assistants.
Professionals provide a comprehensive care plan to patients after the first meeting and monitor each month through daily metrics and readings by healthcare software so that the patient does not have to visit doctors daily.
HealthArc is a healthcare software that allows physicians to easily monitor their patients from a web-based portal easily accessed from laptops, desktops, tablets, and mobile phones.
The HealthArc dashboard provides easy-to-understand daily metrics for physicians to track patient status. It helps healthcare providers improve patient engagement with interactive features to share their reports through messaging and even interact with audio/video calls.
Medicare reimburses health care professionals and other care providers and staff for the medical services provided on the fee structure modules. CMS released the reimbursement fee schedule 2023 for chronic care management, which is stated to be beneficial for healthcare providers.
Reimbursement rates for non-complex chronic care management services:
| CPT Codes | Description | Reimbursement Allowed Amount |
| 99490 | 20 min, clinical staff CCM | $62.16 |
| 99439 | add 20 min, clinical staff CCM | $47.04 |
| 99491 | 30 min, physician CCM | $83.66 |
| 99437 | add 30 min, physician CCM | $59.47 |
| G0511 | 20 min, clinical staff CCM (for RHCs) | $79.25 |
Reimbursement rates for complex chronic care management services:
| CPT Codes | Description | Reimbursement Allowed Amount |
| 99487 | 60 min, clinical staff CCCM | $146.00 |
| 99489 | add 30 min, clinical staff CCCM | $76.51 |
The CCM program provides effective access to healthcare delivery for chronic patients and reduces the risk of hospitalization while reducing costs for patients.
To ensure a successful care process and meet the requirements of the CCM program while providing effective care, follow the best practices outlined below:
Comprehend Eligibility/Ineligibility of Patients
The criteria for every patient eligible for the enrollment in CCM:
CMS provided the example of eligible conditions, including cancer, cardiovascular disease, COPD, and diabetes.
Know Healthcare Professionals Eligible to Bill for CCM
FQHCs, RHCs, certified physicians, and hospitals are eligible to bill for CCM services. The following non-physicians that can also bill for CCM services are:
Obtain Prior Patient Agreement
Physicians must obtain a consent document on their records to meet reimbursement guidelines.
Discussion with patients about criteria such that only one professional can provide CCM services at a time each month will help patients not make any mistakes and create many problems for meeting the reimbursement guidelines.
Establish Comprehensive Care Plans
To fulfill CCM requirements, healthcare providers must provide comprehensive care plans for patients and caregivers.
A care plan should include the following:
Document the Time Spent
The CCM reimbursement and billing criteria are emphasized around the time given for the services. Providers must document the time spent providing CCM services in their records. These include time on calls, prescriptions, reconciliation, and other care coordination and healthcare facilities.
Affiliate with Care Coordination Services
Partnering with care coordination services will be beneficial yet time-consuming for you. HealthArc is one of the best providers to help you deliver better patient outcomes with advanced analytics.
Collaborating with HealthArc will improve patient engagement and care for chronic patients and increase the practice revenue.
The advanced agreement can be both verbal and written. The only thing is that there must be documentation in electronic health records.
Chronic Care Management (CCM) – covers 20 minutes of clinical staff time per month for managing and providing care services for non-complex chronic conditions.
Complex Chronic Care Management(CCCM) – covers 60 minutes given from moderate to severe division, making for complex chronic conditions.
The benefits are both for practitioners and the patients. The providers get the appropriate fees and reimbursements with the CCM billing codes, and the patients receive better healthcare monitoring with enhanced healthcare support from the best healthcare professionals.
As we have tried to convey from this blog article, partnering with care coordination services will enhance your chronic care management services and allow you to focus more on medical work rather than spending time on other managerial and testing tasks.
The HealthArc’s software will take care of all the EHRs and automatically bill for services and reimbursements to save time without any faults. The HealthArc Dashboard provides easy-to-understand daily metrics for physicians to track patient status.
It helps healthcare providers improve patient engagement with interactive features to share their reports through messaging and even interact with audio/video calls.
HealthArc automates the billing reports, which helps physicians reduce the burden, and they can effectively focus on patient monitoring and care services. So contact us today to deploy your CMS Medicare Chronic Care Management Solution.
Schedule a demo today to learn more about billing and reimbursement of chronic care management.