Updated White Paper Addresses Providing and Billing Medicare for Chronic Care Management Services

Updated White Paper Addresses Chronic Care Management ServicesWith the publication of the 2017 Medicare Physician Fee Schedule Final Rule, PYA has released an updated white paper with step-by-step instructions for providing and billing Medicare for chronic care management (CCM).

PYA has released an updated white paper that answers the most frequently asked questions about providing and billing Medicare for CCM.  It provides crucial information related to eligible providers, eligible beneficiaries, performance standards, documentation standards, and recently simplified billing regulations.

In the updated white paper, “Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services),” PYA outlines simplified CCM billing rules effective January 1, 2017.  The paper condenses extensive regulations and the Centers for Medicare & Medicaid Services’ (CMS) guidance, providing a concise summary that helps providers understand the new rules.

“Many physicians chose not to provide ambulatory care management services due to the complicated nature of CMS’ prior billing rules,” said PYA Principal Martie Ross.  “With the recent simplification of the rules as we’ve outlined in this white paper, more providers can implement CCM programs and realize the financial benefits.”

While two-thirds of traditional Medicare beneficiaries—roughly 25 million people—are afflicted by multiple chronic conditions, fewer than 15% of eligible individuals actually received CCM services through mid-2016.  However, physicians were discouraged by overly complex rules and regulations.  In addition to this simplification initiative, CMS also will pay for additional ambulatory care management services, including complex CCM and care plan development.

According to the white paper, “In addition to direct revenue, CCM offers practitioners a bridge over the chasm between fee-for-service and value-based reimbursement.  By developing and implementing a CCM program, a practitioner will grow skill sets and internal processes critical to population health management, all the while receiving fee-for-service payment to support those activities.”


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