CMS is opening up the field of Chronic Care Management in 2017 by implementing new rules. Four major changes make CCM more attractive to physicians.
- Reimbursements now range from $43 to $141 (for complex care).
- Initiating care requirements are lower.
- Reduced payment rules for billing services.
- FQHCs and RHCs are now included.(1)
One thing that has not changed is the CMS rule regarding who can make claims. Only a single provider can bill for CPT 99490 for a patient in a single month. This creates a “land-grab” to see who can enroll a given patient in Chronic Care Management first. Most patients with multiple chronic conditions see multiple doctors, including specialists. As CMS did not restrict specialists from enrolling patients, there is an increased chance that neighboring specialists can enroll even a primary care physician’s patients.
If this was not sufficient reason to act now, more broadly the market is seeing increased competition in the care coordination space itself. More entities realize the value (and potential income) that is being derived from care coordination. Understandably, most patients will not be willing to spend time with multiple coordinators – where is the coordination in that?
Providers should enroll their patients in chronic care management before their patients find those needs met by a federally qualified health center, wellness program, oncology center – the list goes on for entities eager to provide care coordination services – see the framework below for some of those types of organizations. Athena Mandros from Open Minds outlines this heated competition in her article referenced below. (2)
Is Your Organization Ready To Be ‘The’ Care Coordinator?
There is a lot of competition for this care coordination role – among primary care practices, federally qualified health centers, community mental health centers, addiction treatment programs, oncology practices, and more. Why? Because this is a new and highly desirable income stream, but also because the care coordination programs control consumer engagement, clinical decision support, consumer health data, and referrals. The strategic questions behind this development are two-fold – does your organization want to be in the care coordination role and, if so, is your organization ready to do this?
CareHarmony: The Care Coordinator for You
Increased services for your patients will mean increased staff and overhead. However, with CareHarmony, you do not need to make drastic changes. Collaborating with us means taking the worry out of helping those in your practice who need it the most. CareHarmony’s skilled care coordinators and dedicated support staff are what you need to begin a new phase of Chronic Care Management in 2017.
- Centers for Medicare and Medicaid Services, “Chronic Care Management Services Changes for 2017,” 2016. [Online: June 26, 2017] https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagementServicesChanges2017.pdf
- Mandros, Athena, “Is Your Organization Ready to Be ‘The’ Care Coordinator?” Open Minds, 2016, February 17. [Online: June 26, 2017] https://www.openminds.com/market-intelligence/executive-briefings/is-your-organization-ready-to-implement-health-homes.htm/