Chronic Care Management

2/3 of all Medicare beneficiaries have 2 or more chronic conditions. Beneficiaries with multiple chronic conditions were more likely to be hospitalized, had more admissions during the year and higher morbidity rates. This costs Medicare billions each year. Multiple Chronic Care beneficiaries account for 93% of all Medicare spending.

Historically, Medicare has taken the position that payment for non-face-to-face care management services is bundled into the payment for face-to-face evaluation and management (E&M) services. But these payments do not cover the significant staffing and technology investments required for chronic care management, and thus providers do not usually furnish these services. As a result, chronic disease patients are too often left to themselves between episodes of care. That pattern of sporadic care translates into higher complication rates which, in turn, means more suffering and costly care.

Medicare has recognized that care management reduces total costs of care for chronic disease patients while improving their overall health. Now Medicare pays for chronic care management to reimburse for non face to face services provided.

CMS has adopted code 99490 for chronic care services as follows: 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

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