Published March 8, 2018

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

PYA has released an updated white paper offering a succinct list of changes and updated instructions for providing and billing Medicare for chronic care management.

PYA, a national professional services firm with specialized expertise in healthcare consulting and public accounting, has released an updated white paper, “Providing and Billing Medicare for Chronic Care Management Services [CCM] (and Other Fee-For-Service Population Health Management Services).”  It provides updates on crucial information related to eligible providers and beneficiaries, performance and documentation standards, and recently simplified billing regulations for CCM.

The revised paper comes on the heels of a recent analysis by Mathematica, the evaluation contractor for the Centers for Medicare & Medicaid Services.  Mathematica’s report evaluated the impact of CCM in its first two years.  According to the white paper, “The results are impressive:  per-beneficiary-per-month (PBPM) expenditures decreased by $74 for CCM beneficiaries after 18 months.  Most of these savings were realized in inpatient and post-acute care, while Medicare payments to physicians actually increased.”

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“The Mathematica study on the impact of Medicare CCM shows a dramatic decline in the total cost of care for beneficiaries receiving the service,” said PYA Principal Martie Ross.  “Also, these beneficiaries have better outcomes and higher levels of satisfaction with their care.  This provides further evidence to providers that programs like CCM are effective in bridging fee-for-service reimbursement and value-based care.”

CMS began reimbursing physicians for CCM services in 2015.  Initially complicated, CMS made significant changes toward simplifying billing rules and increasing services covered in 2017.  Updates this year were minimal due to the large-scale changes and additions made last year.  Among the most notable recent changes were those faced by practitioners at rural health clinics and federally qualified health centers.  Because of their unique circumstances, CMS added exclusive codes and payment for services delivered at those facilities.  A section addressing these changes also has been added to the recent white paper.

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