Medicare to Pay Primary Care Physicians for Chronic Care Management in 2015

According to the 2014 Medicare Physician Fee Schedule ruling, CMS is moving forward with a new plan to pro- vide separate reimbursement for primary care providers treating patients with multiple chronic conditions. Such conditions must last at least 12 months and result in a functional health decline or risk of death. The payment
is designed to help providers offset the staff and resource burden of providing constant access to patients with complicated conditions that goes beyond the normal in-office service.

Pending changes to the ruling, the new reimbursement model should take effect at the beginning of 2015. Pro- viders will need to report a new “G” code to Medicare no more than once per month to indicate the performance of additional services other than face-to-face contact to help manage the patients’ conditions. The code should pay approximately $40. To fully satisfy the requirements for the payments, providers must:

– Maintain 24/7 access to medical records
– Provide patients with 24/7 access to healthcare providers
– Provide patients with routine appointments
– Organize management of care transitions when needed, including home or community based health services – Offer patients consultation access via phone, secure messaging, or other non-face-to-face methods
– Have patients sign an ABN if they intend to bill the CCM code, so the patients is aware of the monthly charge

This proposal has not been finalized and is still subject to further review and changes.