A Comprehensive Guide To Chronic Care Management (CCM)

Chronic Care Management (CCM) is a subset of virtual care management that focuses on providing coordinated care to patients with chronic diseases, to improve their health outcomes, quality of life, and minimize healthcare expenditures. With the increasing frequency of chronic diseases across the country, CCM has emerged as a crucial component of modern healthcare.

Chronic care management is defined by the Centers for Medicare and Medicaid Services (CMS) as “care coordination services done outside of the regular office visit for patients with two or more chronic conditions expected to last at least 12 months or until the patient’s death, and the condition places the patient at the significant risk of death, acute exacerbation/decompensation, or functional decline.”

To put it simply, chronic care management is a focused approach to healthcare that entails the proactive and ongoing management of chronic illnesses by medical professionals with the goal of enhancing patient engagement, improving patient outcomes, and lowering healthcare costs.

Diagnoses Requirements for CCM Services

The goal of Chronic Care Management (CCM) is to support people who are suffering from two or more chronic diseases that require ongoing medical attention. Remarkably, this criteria applies to about 75% of Medicare beneficiaries. While the precise diagnosis may fluctuate depending on various healthcare policies and contexts, the following are some typical instances of chronic illnesses that are frequently covered under CCM programs:

• Diabetes
• Hypertension (High Blood Pressure)
• Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD)
• Asthma
• Chronic Kidney Disease (CKD)
• Mental Health Conditions

CPT Codes For Billing CCM

Billing for Chronic Care Management requires the use of certain Current Procedural Terminology (CPT) codes. CCM’s major CPT code is 99490, which includes at least 20 minutes of non-face-to-face care coordination and management services per month. This includes creating care plans, communicating with other healthcare practitioners involved in the patient’s care, managing medications, and ensuring 24-hour access to care.

Apart from the 99490 code, there are several CPT codes available to bill for extra time or more complex cases:

99491: A qualified healthcare practitioner personally provides CCM services to patients with multiple chronic illnesses for at least 12 months. It calls for a comprehensive treatment plan and at least 30 minutes of professional attention every month.

99437: Additional CCM services for patients who have had several chronic diseases for at least 12 months. This includes extensive care planning and monitoring. This is an-add-on code for 99491. Every additional 30 minutes per month must be personally administered by a qualified healthcare professional.

99490: Initial CCM services for patients with multiple chronic diseases for at least 12 months. The first 20 minutes of clinical staff time each month must be supervised by a Physician or other qualified healthcare practitioners.

99439: This is an add-on code for 99490. For every additional 20 minutes of clinical staff time guided by a physician or other qualified healthcare professional for chronic care management per month.

99487: Initial complex chronic care management services for patients with various chronic conditions that persist at least a year. It entails thorough care planning for chronic conditions requiring moderate to very complex medical decision-making. The first 60 minutes of clinical staff time each month must be supervised by a Physician or other qualified healthcare practitioner.

99489: More complex chronic care management services for individuals with various chronic diseases that have lasted at least 12 months. Every additional 30 minutes of clinical staff time per month must be supervised by a Physician or other qualified healthcare practitioner.

Principal Care Management (PCM) Codes Related to CCM

99424: This code refers to primary care management services for a single high-risk chronic disease that has lasted at least three months. Complex treatment requires frequent drug modifications and practitioner collaboration. The first 30 minutes of care per month must be personally administered by a qualified healthcare professional.

99425: This code covers additional principal care management services for a high-risk chronic disease that lasts at least three months, such as sophisticated care planning, prescription modifications, and continuous coordination. This is an add-on code for 99424, each additional 30 minutes per month must be personally administered by a qualified healthcare professional.

99426: Initial primary care management services for a high-risk chronic disease that lasts at least three months, including complex care planning and prescription modifications. The first 30 minutes of clinical staff time each month must be supervised by a Physician or other qualified healthcare practitioners.

99427: Additional primary care management services for a high-risk chronic disease that lasts at least three months. This is an add-on code for 99426, every additional 30 minutes of clinical staff time per month must be overseen by a Physician or other qualified healthcare practitioners.

Advantages of Chronic Care Management for Healthcare Providers

• Enhanced Patient Engagement

Chronic Care Management promotes proactive patient participation through regular communication and follow-up between healthcare providers and patients. This ongoing interaction promotes adherence to treatment goals and a collaborative approach to care.

Patients benefit from more tailored treatment plans, medication management, and continued access to care, which results in higher satisfaction, better health outcomes, reduces hospital readmissions and emergency department visits.

• Improved Patient Outcomes

CCM programs can help patients achieve better outcomes by providing continuing care and management for chronic diseases. Regular monitoring, early interventions, and complete care plans and support can help patients stabilize chronic diseases, avoid complications, and improve their overall quality of life.

• Streamlined Care Coordination

Chronic Care Management programs can improve communication and coordination amongst healthcare providers involved in a patient’s care. A multidisciplinary approach that includes physicians, nurses, care navigators, and other healthcare professionals ensures that patients receive thorough and coordinated treatment.

• Reduced Hospital Readmissions

Effective Chronic Care Management programs can considerably minimize hospitalizations and readmissions by preventing s exacerbations, managing complications, and encouraging preventative care. CCM programs may help stabilize chronic illnesses and treat potential difficulties before they escalate, resulting in fewer hospitalizations and associated healthcare expenses.

• Effective Use of Healthcare Resources

CCM promotes proactive management and preventive treatment, which can result in more efficient use of healthcare resources. By emphasizing early diagnosis and intervention, CCM can reduce the need for costly and extensive procedures including hospitalizations, surgeries, and emergency department visits.

• Compliance with Regulatory Requirements

Adopting CCM can assist healthcare providers meet regulatory criteria and standards defined by the Centers for Medicare and Medicaid Services (CMS). Providers may guarantee that CCM services are accurately billed, documented, and reported, avoiding penalties and remaining compliant with healthcare laws.

• Diversify Revenue Streams

Another advantage of implementing Chronic Care Management is the opportunity to diversify revenue streams through Medicare reimbursements. Providers’ bill for CCM services with specific Current Procedural Terminology (CPT) codes, including 99490, 99487, and 99489. These codes enable healthcare professionals to be reimbursed for non-face-to-face care coordination and management services offered to patients with chronic diseases.

How To Implement A Successful CCM Program?

It is critical to efficiently manage your CCM workflow in order to meet eligible patients’ monthly Chronic Care Management (CCM) needs. The steps below will help you start and implement a CCM program:

• Determine Patient Eligibility: Confirm their eligibility and validate their Medicare coverage.
• Update the Eligible Patient List: Regularly check and update the list to account for new enrolees and those who are no longer eligible.
• Educate Patients: Inform eligible patients about how CCM can help them manage their health conditions and improve their quality of life.
• Secure Patient Consent: Obtain patients’ explicit verbal or written consent to complete the enrolment procedure.
• Meet Individual Patient Needs: Be proactive in addressing any healthcare-related issues or needs that the patient may have.
• Address Social Determinants of Health (SDOH): Identify and address variables such as living conditions, economic stability, and social environment that can affect patients’ health and access to healthcare.
• File Claims Efficiently: To ensure correct reimbursement, submit billing information on time and with accuracy.
• Ensure Quality and Compliance: Regularly assess the quality of care delivered and ensure that your program complies with all applicable legislation and standards.

Choose HealthArc’s CCM Software For Better Patient Outcomes

Starting a CCM program with an emphasis on virtual care has the potential to greatly improve chronic care management and patient outcomes. HealthArc’s digital health platform enables healthcare providers to establish clear chronic care management goals and outcomes, making it convenient and accessible.

Our CCM software is designed to scale your healthcare results and make patient care and management easy. Our suite of patient communication and interaction capabilities, a dedicated customer success team, clinical software, physician dashboard, and billing capabilities provide a comprehensive solution to establish a successful CCM program.

Please request a free demo to learn about how we can help your organization achieve its care management goals. Also, feel free to talk to our team at +201 885 5571 for any queries.