Chronic Care Management – Are you getting paid for the work already being done?

Chronic Care Management – Are you getting paid for the work already being done?

Do your primary care staff spend countless hours following-up with and coordinating the care of repeat patients? Have you ever heard or thought:

“I wish I had a dollar for every time I take a call from Fred’s daughter about his diabetes” – Caregiver Support

“This home health agency should pay me for every patient I refer to them” – Coordination of Care

“The doctor wants you to fax us a record of Fred’s daily finger sticks. I will make sure the doctor sees them and calls you back with any changes he may want.” (One more thing to keep track of!) – Monitoring

Most organizations would agree that they are not adequately compensated for the time and effort spent supporting their chronically ill patients. Compassionate staff and physicians do strive to provide the best possible health care for these (frequently) elderly, chronically ill patients, but feel the work and time spent on a daily basis monitoring, educating, coordinating care, and following up with these patients goes unrecognized and unpaid.

In 2015, CMS validated this need by delivering a new CPT code, 99490, and stating that “Chronic Care Management (CCM) may help avoid the need for more costly face-to-face services in the future by proactively managing patient health, rather than only treating disease and illness.”1

The 99490 code can help cover the cost of chronic care management by paying up to $40 per month for these services. It specifies the details needed to report and get reimbursed for the services many organizations are already be providing. The struggle lies in meeting the requirements of tracking, care planning, and documenting these services so bills can be submitted and defended during an audit.

Per the CMS MLN 99490 definition:

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.1

Physicians and practice managers need to consider several implementation processes when contemplating billing for code 99490.

  • Identification and training of eligible clinical staff to make calls and document the findings
  • Establishing required record keeping and detailed logs
  • Identification of eligible chronic care patients
  • Obtaining and tracking required consent from the patient for the CCM service
  • Coordination with your EHR for documentation, care planning and data entry

If you are looking for help and guidance implementing a Chronic Care program for Code 99490, Galen Healthcare Solutions has developed a comprehensive Chronic Care Management program to assist you.

This is program includes:

  • CCM Program Development with documented workflows/processes and identification of gaps for success,
  • Care plan development in the Electronic Health Record,
  • Reporting Tools to track the time spent with patients,
  • Assistance in rapid enrollment of patients/program oversight to improve adoption and revenue return on investment.

Join us for a free webcast on December 9 to hear how your organization can begin their CCM program or contact us below for more information:


1 MLN/MLNProducts/Downloads/ChronicCareManagement.pdf


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