Chronic care management is a healthcare service dedicated to people living with chronic medical conditions. However, getting this service requires knowledge – who can have the service, how much it costs, whether insurance covers it, etc. This post focuses on the requirements to bill for chronic care management.
What is Chronic Care Management?
Chronic care management seeks to provide the best medical care for people living with one or more chronic illnesses. We offer the best individualized chronic care management plans at the Health and Wellness Medical Services in Charlottesville, Virginia. Our individualized plans may include house calls, chronic care plans, 24/7 access to health care, and prescription management.
Chronic care management aims to help patients live life to the fullest. It helps patients living with chronic conditions to manage their health care; the service also extends to elderly patients. The service will allow patients to reduce hospital visits, increase longevity, and enjoy a higher quality of living.
What are Chronic Conditions?
There are three qualifiers for chronic conditions. They are:
- A medical situation that lasts for more than a year or until the death of the patient
- Requires continuous medical care and maintenance
- Limits the patient’s ability to fulfill daily activities – puts the patient’s life at risk of death, acute exacerbation, decompensation, or functional decline.
Examples of chronic conditions include:
- Heart disease
- Parkinson’s disease
- Kidney disease
- Chronic obstructive pulmonary disease (COPD)
How is the Health and Wellness Medical Services Chronic Care Management Different?
The Health and Wellness Medical Services coordinates care with the University of Virginia Health and Sentara Martha Jefferson Hospital. We accept and work with Medicare and Medicaid because we believe that chronic care management is a vital service and that everyone who needs it should have access to it.
Our comprehensive chronic care management plans are highly personalized and may include:
- A list of your chronic conditions
- Your desired outcome
- Expected prognosis
- Measurable treatment goals
- Symptom management plan
- Medication management plan
- Establish interventions and the list of individuals responsible for each intervention
- Necessary community and social services
- Description of how external specialists will help
- Schedule for checkups and reviews
- Lifestyle changes outline
- Nutritional guidance
- Blood sugar management plan
- Exercise plan
What are the Requirements to Bill for Chronic Care Management?
There are a lot of requirements to bill for chronic care management. Our goal is to help you navigate the billing process’ ins and outs. Let’s begin.
Billing for Chronic Care Management to Medicare
Medicare can reimburse for chronic care management using the CPT Code 99490. CPT stands for Current Procedural Terminology – medical codes used to report medical procedures or services to entities such as physicians or health insurance companies.
The service is for patients with multiple chronic situations who require non-face-to-face treatment. Here’s how to obtain chronic care management reimbursement.
You must have a document that proves that a clinical staff spent twenty minutes or more of non-face-to-face time during the month. You should record the date, time spent, the provider’s name, and the services provided in the document.
Bill Medicare using the CPT code 99490. Each patient should only bill this code once per month. Aside from using the CPT code 99490, you should also include the CPT codes for each chronic condition.
You should never round up when documenting the non-face-to-face time the presiding medical staff spent. The documentation should accurately note the time in total minutes. For example, clinical staff will record 4 minutes instead of 09:34 – 09:38.
It is also important not to note the same number of minutes as a habit, even though it is easier to document 5-minute intervals. Precision and accuracy are crucial because maintaining a constant 5-minute interval is unrealistic. Should an audit occur, an unrealistic record will be less favorable compared to an accurate record?
Only one physician or healthcare professional who takes part in the patient’s care management can bill for providing chronic care management. Even if any clinical staff person can provide the services for the patient, the service should be billed under any of the following:
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Certified nurse-midwife
Billing Using Other CPT Codes
The CPT code 99490 is only for non-complex chronic care management in which the medical staff spends only twenty minutes coordinating care across different providers and supporting patient accountability. Other CPT codes apply for care received outside the scope of code 99490.
For each additional twenty minutes spent by the medical staff providing non-complex chronic care management, the bill should use the CPT code 99439. This bill comes in conjunction with the CPT code 99490.
For any complex chronic care management, the bill should come under code 99487. The same qualifying factors apply to non-complex and complex chronic care management, except complex management requires higher complex medical decision-making. Also, code 99487 requires around sixty minutes of care under the direction of a qualified healthcare professional each calendar month.
The service should be billed under the code 99489 for each additional thirty minutes of clinical staff time for complex chronic care management under the direction of a qualified healthcare professional each month. This bill comes in conjunction with code 99487.
If a physician or other qualified healthcare professional provides services personally for at least thirty minutes, the bill comes under code 99491.
All of these details must be intimidating. But don’t worry; any competent healthcare professional will explain these proceedings and should help you navigate them should you have any questions or concerns.
Health and Wellness Medical Services is Here to Help You
Our primary goal in providing chronic care management is to help patients live the highest quality of life possible. To that end, we are prepared to assist you in receiving the best care possible.
If you have any questions or concerns regarding chronic care management, feel free to contact us at 434-933-3318. Our offices are at 1560 Insurance Lane, Charlottesville, VA 22911, and 1171 North Main Road, Madison, VA 22727.