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November 26, 2019 | CMS Expands Access to CCM Signaling the Initial Success of the Program

CMS released its 2020 Care Management provisions and, for the third consecutive year, will add new codes and regulations that increase the ability for health care providers to adopt and expand their care management initiatives. The changes, announced on November 1, will be effective for services furnished on or after January 1, 2020.

These updates to policy and additional codes are a strong indicating factor that care management is delivering on its desired results and is worthy of further investment and expansion. With only 9 percent of Medicare fee-for-service beneficiaries currently receiving ambulatory care management services, this expanded access is an opportunity to improve quality of care, patient experience and engagement for people living with chronic illness.

The updated policy changes will affect transitional care management (TCM), chronic care management (CCM), and remote patient monitoring (RPM).  It also introduces a new service for people with one chronic condition called Principal Care Management (PCM).

Transitional Care Management

CMS included updates within its proposal to help increase TCM utilization and recognize providers that manage patients’ care after they leave the hospital. These updates include an increase in Medicare reimbursement as well as the ability to bill for TCM services in addition to CCM services in the same time period. This is important because people living with chronic conditions are more likely to have complications and additional health concerns after being hospitalized.  Following up with your doctor to ensure everything is moving in the right direction helps decrease the chance of hospital readmission.

Chronic Care Management

We are especially looking forward to the changes made within CCM that can positively impact patients. Additional codes that can be used in two twenty-minute increments gives our nurses an opportunity to have longer, more insightful conversations.  This allows up to 60 minutes of time spent on a patient without the requirement for complex decision making. This is important specifically when a patient needs a little extra care or has a change in their health status that requires additional time but does not qualify under the complex code.

Principal Care Management

With the introduction of PCM services, patients who have a single high-risk medical condition like diabetes or heart disease can now receive access to care management services. This will prove to be highly valuable as a means of preventative care, specifically as it relates to managing conditions that have a high likelihood of causing other problems over time.

To avoid payment for duplicative services, CMS included two additional requirements for PCM. These include “(1) the practitioner billing for PCM must document in the patient’s record ongoing communication and care coordination between all practitioners furnishing care to the beneficiary, and (2) the practitioner cannot bill for interprofessional consultations or other care management services,” according to PYA. This gives providers two options for helping people living with one chronic condition proactively manage their health – PCM or RPM.

Remote Patient Monitoring

Prior to 2020, CMS required healthcare providers to discuss RPM in-person. Now, general supervision will be permitted. This shift from direct to general supervision will allow Wellbox, and other providers, to conduct RPM services remotely and in parallel to CCM services.  Access to accurate and timely data from remote monitoring devices will give our nurses the ability to suggest better goals and interventions and assist people in achieving those goals in measurable ways.  It will also help us better coordinate the care of the patient by alerting their healthcare provider of any concerns in the data faster and more efficiently.

 

With the additional codes and policy updates, the people who need assistance managing their conditions can now have greater access to helpful care coordination. If you’d like to learn more about the 2020 Medicare Physician Fee Schedule Final Rule, you can read more about it here.