2017 changes to Chronic Care Management in Rural Health Clinics

by Debbie Mackaman, RHIA, CPCO, CCDS

Beginning January 1, 2015, Medicare began to pay separately under the Medicare Physician Fee Schedule (MPFS) for CPT code 99490 (non-face-to-face care coordination services furnished to patients with multiple chronic conditions). However, payment for chronic care management (CCM) provided in rural health clinics (RHC), which are usually paid an all-inclusive rate (AIR), was not available until 2016.

As demonstrated through various payment models and pilot projects, CMS recognized that care management is one of the critical components of primary care that contributes to reduced spending through improved healthcare. However, RHCs have faced several challenges in providing the service, including meeting supervision requirements and having the technology required to provide CCM in rural and remote areas where independent RHCs may have lacked electronic health record (EHR) capabilities.

In general, CCM can be provided when all of the following criteria are met:

• The patient has at least two or more chronic conditions that are expected to last at least 12 months or until the death of the patient 
• The chronic conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline  
• A comprehensive care plan is established, monitored, and revised as needed by the physician or other qualified practitioner
• A minimum of 20 minutes of clinical staff time is provided under direct supervision by a physician or other qualified healthcare professional per calendar month

If the 30-day period ends before the end of a calendar month and at least 20 minutes of CCM services are subsequently provided during the same month, both transitional care management (TCM) and CCM can be appropriately billed only if there is no overlap in time between the two services.

To read the complete article on Medicare Compliance Watch, click here.