Frequently Asked Questions
- Transitional care management (TCM, CPT 99495 and 99496)
- Home health supervision (HCPCS G0181)
- Hospice care supervision (HCPCS G0182)
- Certain end-stage renal disease (ESRD) services (CPT 90951-90970)
The exception to these four situations concerns TCM. The same practitioner may bill for both TCM and CCM in the same calendar month for the same beneficiary if the 30-day post-discharge service period for TCM concludes before the end of that calendar month and you have provided at least 20 minutes of CCM services between the time TCM ended and the last day of that month.
The first step in beginning the CCM program is to identify all of your Medicare patients who have two or more chronic diseases that fit the eligibility requirements for this program. Once you have this list, you should schedule a face-to-face appointment with each of these patients. For example, you could inform patients about the program during a wellness check, annual physical or regularly scheduled lab. You can’t bill CCM for these types of face-to-face visits but your regular office visit fees will apply. Use the information that ChronicCareIQ provides to explain the program to your patients.
To obtain patient consent you must:
- Identify the provider who will furnish the CCM services and explain that only one practitioner can furnish and be paid for these services in a one-month time period.
- Explain that these services are non-face-to-face and that cost sharing will apply. Typically, this cost sharing fee averages around $8 to $9 a month. This co-pay is most likely paid for by supplemental insurance, but you should also help the patient understand the benefits they will realize from this enhanced patient engagement such as improvements in overall health and outcomes.
- Tell the patient they have the right to stop the CCM services at the end of a calendar month once they have started the program.
- Provide a written or electronic copy of a comprehensive care plan to the patient which is documented in the electronic medical record.
- Document in the medical record all of the elements of the CCM program that were explained and offered to the patient and note whether or not the patient accepts or declines the services.
You should also recognize these CCM services are most likely already being provided to the patient by your practice but you are not getting paid for them!
If your patient doesn’t have a smartphone, ask if they have a tablet or desktop computer, or if their caregiver has a smartphone. If they simply do not have the technology to use the application, a member of your staff can call them and enter their information into the dashboard to comply with the program.
Using a spreadsheet to track the CCM program is time intensive for your staff which means they have less time to spend with the patient. ChronicCareIQ automates the whole non-face-to-face encounter and workflow making it easier, efficient and effective for your staff to manage. Also, CMS requires a comprehensive documentation of time spent with the patient and may audit your program. The ChronicCareIQ application provides extensive documentation for audits that will save you time and money if you are audited.