According to CMS, practitioners can count the time they spend reviewing patient physiological data towards the monthly minimum time required for billing the CCM code. This time counts towards the 20-minute performance required for CPT code 99490. Moreover, CMS (Care Management Services) recognizes primary care and care coordination as crucial for achieving better care outcomes. Therefore, since 2017, CMS has encouraged long-term investment in primary care and care management services through accurate payment.
Reimbursement and Billing Simplification
Since 2017, CMS has introduced several changes to simplify chronic care management (CCM) billing and expand reimbursement options:
- Simplified billing rules for CCM.
- Monthly payments for complex CCM, which involves 60 minutes of care for patients with chronic medical problems requiring moderate or high medical decision-making.
- Payments for developing care plans.
- Transition from direct to general supervision for CCM provided by rural health clinics (RHCs) and federally qualified health centers (FQHCs).
How CMS is Simplified and How Esvyda Can Help
Consent Form: A physician can now document the beneficiary’s consent in the medical record instead of requiring a separate form.
Esvyda’s Solution: We keep patient information accessible in your EHR system anytime, anywhere, thanks to our powerful interoperable capabilities.
Initial Visit: An initiating visit is required only for new patients or those not seen in the past twelve months.
Esvyda’s Solution: keeping all encounter information secure and providing insights into the patient’s treatment, whether online or face-to-face.
24/7 Access to Care: The requirement for 24/7 access to the beneficiary’s care plan has been removed.
Esvyda’s Solution: Nevertheless, we still enable access to the patient’s care plan in a user-friendly manner, ensuring it is available anytime to patients and authorized persons.
Management of Care Transitions: The continuity of care document no longer requires a specific format.
Esvyda’s Solution: Consequently, we enhance communication capabilities, such as SMS, chat, and video/audio interaction, to facilitate care transitions. Care team members can share comments and seek advice without disclosing patient health information (PHI).
Sharing Clinical Summaries and Care Plans: Care plans and clinical summaries must be available electronically within and outside the billing practice.
Esvyda’s Solution: Therefore, our interoperable capabilities allow health care providers to share care plans and clinical summaries with patients, their authorized persons, and other health care providers involved in their treatment.
How CMS is Simplified and How Esvyda Can Help
Care Plan Format: The format for providing the care plan to the patient is no longer specified.
Esvyda’s Solution: Similarly, we support the sharing of care plans and clinical summaries in various formats, ensuring easy access for patients and their authorized persons.
Documentation in the EHR: Practitioners must document communications in the patient’s medical record, but they do not require a certified electronic health record.
Esvyda’s Solution: Moreover, we integrate all documentation related to CCM programs into your EHR, ensuring availability anytime, anywhere.
Esvyda works closely with public and private health plans in all of their available programs, making our solution the most complete out there in the market.
