Frequently Asked Questions

You’ve got questions; we’ve got answers. Chronic care management can be rather complex, leaving many providers with numerous questions. Below are the most common questions we receive.

Chronic Care Management, at least when speaking in the context of Medicare billing code 99490, is providing non face-to-face care for chronically ill patients between office visits in an effort to address all of the issues that may impede a patient’s ability to manage their conditions and adhere to the care plan. Fundamentally, it is designed to provide enhanced care for the patients most in need who account for the highest utilization (highest cost).

Per the CMS Final Rule, “Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.”

Any Medicare patient with 2 or more chronic conditions is eligible for this program. CMS intentionally left the definition of “chronic conditions” open to discernment by the provider.  CMS guidelines simply requires the patient to meet the following criteria:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation

CMS did not limit chronic care management to one practice area. While primary care is the most logical place, any provider can implement and bill for chronic care management. Gynecology and gastroenterology that may have a patient population that can support a chronic care management program. Conversely, chronic care management may not be a good fit for surgeons as there are limitations on what can be billed for during the post-op period.

The complexities of Chronic Care Management are numerous, from adopting the right technology to achieving efficiency and to mitigating the risk of audits to the allocation of resources to adequately meet the needs of your patients and requirements of the program. While some practices attempt to do it themselves, most fail. Here are just a few considerations:

  • Requires a minimum of 20 minutes per month. However, in reality, it requires significantly greater care—in the range of 30-40 minutes.
  • Requires you to provide patient access to clinical staff 24/7/365
  • Would likely require you to adopt new technology, requiring a capital investment and causing your staff to learn yet another software application.
  • Requires maintaining detailed records of all care coordination that CMS may require you to furnish upon an audit.
  • Depending on your practice size, it may require a large clinical team, requiring space your may not have or are not willing to allocate to this program.

CareHarmony has designed a program to minimize the time demand on your practice. We custom tailor our programs based on the amount of interaction/involvement each provider wants. You will spend time in three areas: enrolling patients, reviewing care plans (optional), and submitting billing to CMS for reimbursement. We handle everything else! And, because we are staying in contact with patients between office visits, we are able to eliminate many of the phone calls, activities your staff would normally handle.

The simple answer is no. While it is possible a few patients may be able to avoid office visits because they are now able to better manage their chronic conditions, we will be actively promoting the annual wellness visits as part of our care plans. You should expect to bill for considerably more wellness visits once the chronic care management program has been implemented.

With CareHarmony, the patient enrollment process has been designed for extreme efficiency.   From identifying which patients are eligible and coordinating visits with the front office to obtaining a signature on the patient consent form, our process was designed to minimize the friction.   We provide practices professional patient materials to educate your patients and facilitate enrollment when the service is prescribed.

CMS requires the billing practitioner to furnish an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), or comprehensive evaluation and management (E&M) visit to the patient prior to billing for Chronic Care Management billing code 99490. The practitioner must initiate the Chronic Care Management service as part of the exam/visit.

Only one provider may bill on any given month. This requirement is clearly outlined on the consent form. To be eligible to participate, the patient would need to withdraw from the other program prior to enrolling in your chronic care management program. This underscores the urgency to begin a chronic care management program sooner rather than later. You don’t want to have this opportunity pass you by.

At CareHarmony, we focus on the services that provide the greatest gains in health and well-being. Beyond building the custom care plan, a requirement of 99490, we strive to achieve continuity of care for the patient across all providers.

Care Coordinators are available 24 hours per day, 7 days per week, via phone, email, and in-app messaging to help patients schedule appointments with the designated provider and ensure comprehensive health information is consistently shared with the entire care team.

Based on the patient’s unique needs, we perform a series of assessments and update the care plan accordingly. We gather key insights from the client and create tasks, medication & measurement reminders, etc. to help the client better manage their chronic conditions.

The simple answer—Yes!

No. CareHarmony is not an EMR, nor do we require you to change yours if the EMR is 2014 meaningful use certified. As the only Chronic Care Management solution on the market with enterprise class integration capabilities, we are able to interface with your EMR to gather the information we need and then build a comprehensive, longitudinal record within our proprietary care coordination platform.

CareHarmony’s care coordination platform was purpose built to help providers transition to and thrive in all forms of value-based care. As such, it possesses the latest technologies for the electronic sharing of patient records and communication.

Yes.  There are four types of services that would prevent us from billing for Chronic Care Management for a given month, as the care management component is built into these services already:

  • Transitional Care Management (99495, 99496)
  • Home Healthcare Supervision (G0181)
  • Hospice Care Supervision (G0182)
  • Certain ESRD codes (90951-90970)

Medicare and Medicare Advantage plans. Some Medicaid programs also offer some variations of a chronic care management program. Also, commercial plans are evaluating chronic care management and may adopt similar programs in the near future.

The average reimbursement is $41.44. This amount varies by location. See our revenue calculator to find the reimbursement rate in your area.  The 2015 Medicare physician fee schedule assigns 0.61 relative value units (RVUs) to code 99490.

No. Code 99490 is for 20 minutes “per calendar month.” You cannot add time up over multiple months to report 99490.