TRANSITIONAL, REMOTE, CHRONICCARE&PRINCIPAL CARE

- Communication and Remote Patient Monitoring (RPM):

Effective communication between healthcare providers and patients is crucial for successful chronic disease management CCM services often involve regular telephone or electronic communication between the patient and the healthcare team Additionally, the use of remote patient monitoring devices, such as blood pressure monitors or glucose meters, can provide valuable data to assess the patient's condition remotely

- Medication Management:

Ensuring proper medication management is essential in chronic care CCM services may include medication reconciliation, monitoring adherence, and providing education to patients about their prescribed medications This component helps optimize medication regimens, minimize adverse effects, and improve treatment outcomes.

- Enhanced Access and Continuity of Care:

CCM services aim to provide patients with increased access to care and enhance continuity. This includes same-day or next-day appointments for urgent needs, extended office hours, and 24/7 access to healthcare providers for urgent issues

Timely access to care helps manage exacerbations, address concerns, and prevent unnecessary emergency department visits.

Billingand CodingConsiderationsfor CCM:

- Eligibility: CCM services are typically eligible for Medicare reimbursement. Ensure that the patient meets the specific criteria outlined by Medicare or other payers for CCM services, such as having two or more chronic conditions that are expected to last at least 12 months An initiating visit is required for patients who have not seen the billing practitioner within the past 12 months

- Time-Based Billing: CCM services are billed based on the total time spent on care management activities during a calendar month. This includes both the time spent by the physician or other qualified healthcare professional and the clinical staff. CCM services are not typically face-to-face but require a minimum of 20 minutes of services before billing. See CorroHealth TCM, CCM, RPM, PCM Table for more information.

- Documentation: Accurate and detailed documentation is crucial to support the medical necessity of CCM services. Document the time spent on care management activities, details of care coordination efforts, medication management, and patient communication

- Reporting Services:

- CCM initial visit may be a Face-to-face evaluation and management visit, an Annual Wellness Visit (AWV), or an Initial Preventative Physical Exam (IPPE) for a patient the billing practitioner has not seen in the previous 12 months The practitioner must discuss the CCM with the patient If the initiating visit requires a comprehensive assessment and care planning, G0506 (Comprehensive assessment of and care planning by the physician or other qualified health care practitioner for patients requiring CCM services (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service) may be billed as part of the initiating visit

- Both complex and non-complex CCM services cannot be reported for the same patient during the same calendar month 99491 (CCM? multiple? first 30 minutes provided personally by a physician or other healthcare professional) may not be reported in the same calendar month as 99487 (CCM? multiple? first 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional), 99489 (CCM? multiple? first 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional) or 99490 (CCM? multiple? first 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional)