CMS: Billing for CCM on last day could result in NO pay! - DoctorsManagement CMS: Billing for CCM on last day could result in NO pay! - DoctorsManagement

CMS: Billing for CCM on last day could result in NO pay!

By Sean M. Weiss, CPMA, CPC, CPC-P, CCP-P, ACS-EM | November 20, 2014

Medicare’s chronic care management (CCM) services can be a revenue booster, but you may have to compete with other providers to get paid for them. CMS only pays for CCM once per month per patient, which means if more than one provider tries to bill for CCM for the same patient, the first provider who billed it will be paid. The revelation came during a Nov. 19 question-and-answer session by a CMS official at the AMA’s CPT and RBRVS Annual Symposium in Chicago.

CCM, which is billed using the new code 99490, pays $40.39 once a month per patient. What’s the big deal with CCM? It can be used to obtain reimbursement for work that many providers already do: CCM pays for non-face-to-face services to beneficiaries who have two or more significant, chronic conditions, and it can be billed incident-to.

CMS, represented by Kathy Bryant, director of the Division of Practitioner Services, made the following clarifications about CCM:
Don’t simply bill on the last day. 99490 is based on providing at least 20 minutes of care to eligible patients (i.e. those meeting the chronic conditions requirement). Because the time is cumulative, you may be tempted to bill 99490 on the last day of the month. This may result in no payment if another provider bills 99490 before you for the same patient. Tip: Instead, bill 99490 on the same day that the 20-minute or more time requirement is met, Bryant suggested.
Any place of service code is acceptable. Because CCM pays for non-face-to-face services, you can use any place of service code on the claim, Bryant said.
Look for more detailed guidance on the new CCM services in the next issue of DoctorsManagement’s monthly Business of Medicine newsletter, which is delivered via email during the first week of each month.

If any further news breaks from the AMA symposium, you’ll hear about it thanks to our team members who are on-site, including Shannon DeConda, Director of Coding and Partner, Regan Tyler, Senior Consultant and NAMAS Instructor and Sara San Pedro, Senior Consultant and NAMAS Instructor.