Per the CMS Final Rule, "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."

CMS did not limit chronic care management to one practice area. While primary care is the most logical place, any provider can implement and bill for chronic care management. Gynecology and gastroenterology that may have a patient population that can support a chronic care management program. Conversely, chronic care management may not be a good fit for surgeons as there are limitations on what can be billed for during the post-op period.

PharmaneekCare has designed a program to minimize the time demand on your practice. We custom tailor our programs based on the amount of interaction/involvement each provider wants. You will spend time in three areas: enrolling patients, reviewing care plans (optional), and submitting billing to CMS for reimbursement. We handle everything else! And, because we are staying in contact with patients between office visits, we are able to eliminate many of the phone calls, activities your staff would normally handle.

The simple answer is no. While it is possible a few patients may be able to avoid office visits because they are now able to better manage their chronic conditions, we will be actively promoting the annual wellness visits as part of our care plans. You should expect to bill for considerably more wellness visits once the chronic care management program has been implemented.

With PharmaneekCare, the patient enrollment process has been designed for extreme efficiency. From identifying which patients are eligible and coordinating visits with the front office to obtaining a signature on the patient consent form, our process was designed to minimize the friction. We provide practices professional patient materials to educate your patients and facilitate enrollment when the service is prescribed.

CMS requires the billing practitioner to furnish an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), or comprehensive evaluation and management (E&M) visit to the patient prior to billing for Chronic Care Management billing code 99490. The practitioner must initiate the Chronic Care Management service as part of the exam/visit.

Only one provider may bill on any given month. This requirement is clearly outlined on the consent form. To be eligible to participate, the patient would need to withdraw from the other program prior to enrolling in your chronic care management program. This underscores the urgency to begin a chronic care management program sooner rather than later. You don’t want to have this opportunity pass you by.

Yes!

No. PharmaneekCare is not an EMR, nor do we require you to change yours if the EMR is 2014 meaningful use certified. As the only Chronic Care Management solution on the market with enterprise class integration capabilities, we are able to interface with your EMR to gather the information we need and then build a comprehensive, longitudinal record within our proprietary care coordination platform.

PharmaneekCare’s care coordination platform was purpose built to help providers transition to and thrive in all forms of value-based care. As such, it possesses the latest technologies for the electronic sharing of patient records and communication.

Medicare and Medicare Advantage plans. Some Medicaid programs also offer some variations of a chronic care management program. Also, commercial plans are evaluating chronic care management and may adopt similar programs in the near future.

The average reimbursement is $41.44. This amount varies by location. See our revenue calculator to find the reimbursement rate in your area. The 2015 Medicare physician fee schedule assigns 0.61 relative value units (RVUs) to code 99490.

No. Code 99490 is for 20 minutes “per calendar month.” You cannot add time up over multiple months to report 99490.