(Last Updated On: October 11, 2017)

Implementing Chronic Care Management at FQHCs is an expanding field. Centers for Medicare and Medicaid Services (CMS) is boosting this trend with  their proposed changes to the Physician Fee Schedule for 2018. Many FQHC administrators are wondering how it will affect them. The big take away is the continued support for expansion of Chronic Care Management enrollment. With CCM’s success in improving quality of care for patients in other provider groups, CMS is looking for ways to make implementation of CCM smoother for FQHCs. By streamlining CCM processes for FQHCs in 2018, CMS is hoping to increase enrollment and lower billing and reporting burdens. With these changes, Chronic Care Management will be a much better fit for FQHCs.

  1. Combined coding of 99490, 99487, and G0507 into GCCC1
  2. Consistent with other FQHC payment methodology of averaging actual cost
  3. Eliminates tracking of additional time once 20-minute threshold is met
  4. Cannot be billed with TCM or home health supervision
  5. Can be billed with other services furnished during FQHC visit
  6. Claim submitted on or after 1/1/2018 for CPT 99490 will not be paid

Combined with the changes from 2017, CMS is generating momentum for Chronic Care Management implementation in FQHCs. CareHarmony is strategically positioned to assist FQHCs with both CCM and TCM. As the new year approaches, now is the time to prepare for the new Physician Fee Schedule.

Resources:
  1. Centers for Medicare and Medicaid Services, “Proposed New Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs),” August 1, 2017.  https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-08-01-CCM-Call-Presentation.pdf and https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-08-01-CCM-Call-Transcript.pdf
  2. Centers for Medicare and Medicaid Services, “Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018,” July 13, 2017. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html