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Changes to Chronic Care Management Requirements Encourage Adoption in 2017

Recently, Centers for Medicare and Medicaid Services (CMS) has made revisions to Chronic Care Management (CCM) services after reviewing the slow adoption rates in 2016. These revisions are meant to clarify and simplify the billing requirements; changes made to CPT Code 99490 are intended to result in improved health of the high-risk population, and increased claim numbers.

The CPT 99490 changes are as follows:

  • Use of certified electronic health record (EHR) remains a core requirement, but electronic transmission of clinical summaries and care plans can now be made by fax, and that will be counted toward electronic submission.
  • A care plan must be provided to the patient, but access to the care plan is no longer required outside of normal business hours.
  • The format of the care plan provided is no longer specified, and is not a condition of CCM payment the care plan may be provided in hard copy or electronic form as the patient  prefers.
  • Clinical Summaries (aka Continuity of Care Documents) in managing care transitions must simply be done in a timely and consistent manner. There is now no defined standard for method of transport or exchange.
  • 24/7 access to care for “urgent chronic care” needs is now “urgent” needs: patients and caregivers are provided with a means to make timely contact with healthcare professionals to address all urgent care needs, not strictly those related to chronic conditions.
  • Communication with home and community-based providers regarding the patient’s functional deficits and psychosocial needs must be documented in the patient’s medical record. That record is not necessarily required to be within a certified EHR.
  • New clarification: the services that qualify for 99490 are only non-face to face services provided by an office staff member under the supervision of the provider. While this was the direction most practices were encouraged to follow in 2016, CMS has made it official in the new rules. No face-to-face contacts or other professional staff contacts are allowable for 99490.  

CMS has also reevaluated the consent provisions in CPT Code 99490. The practitioner and patient may decide the way they wish to establish consent to CCM services. Consent can be completed if the patient was seen within the last 12 months. The definition and terms of CCM must still be clearly explained to the patient, but a written agreement is not required; documenting in the medical record that the required information was explained and the patient accepted or declined the services is now sufficient.

In 2017, the requirement that CCM may only be initiated during a Medicare annual wellness visit, initial preventive physical exam, or face-to-face evaluation visit applies only to new patients or those patients not seen within one year, rather than to all patients. Also, an initiating visit may be billed along with a qualifying visit if the patient was not a previous recipient of CCM.

The Diary CarePro app makes it easy for providers to adopt billing for Chronic Care Management, and increases ease of workflow as well as patient and care team communications. With the new CMS changes, 2017 promises to bring greater adoption of CCM services, resulting in increased claims and improved health of the Chronic Care population – a win-win for patients and providers alike.



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