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Published February 24, 2020

Make It Simple—Latest PYA White Paper Explains Medicare Reimbursement for Care Management Services

PYA’s latest white paper simplifies complex Medicare billing rules for care management services.

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.” The white paper includes changes from the 2020 Medicare Physician Fee Schedule Final Rule (Final Rule).

According to the Centers for Medicare & Medicaid Services (CMS), chronic care management (CCM) is “increasing patient and practitioner satisfaction, saving costs, and enabling solo practitioners to remain in independent practice.” Yet, only a small percentage of eligible beneficiaries receive CCM, due in part to providers’ concerns regarding reimbursement.

“This white paper helps providers gain a better understanding of CCM billing rules, so they can take advantage of the opportunity,” said PYA Principal Martie Ross. “Using a Q&A format, we address beneficiary eligibility, care plan development, practice capabilities, staffing, supervision, service requirements, documentation, and claims submission for CCM. Also, we cover the new CCM add-on codes, new reimbursement for principal care management, and care management for rural health and federally qualified health centers.

PYA first published its CCM white paper in 2015, when CMS began reimbursing physicians for these services. As CMS has updated billing rules and expanded reimbursement, PYA has updated this resource on which numerous providers have relied in developing their CCM programs.

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