Author: Jeff Tormey

If you are a healthcare provider, then there is a good chance that you have patients who need chronic care management. These patients may be on Medicare or Medicaid and require more frequent visits with their specialist to monitor their condition. This post will explain CCM billing guidelines 2021 so that you can get paid for the time and resources that it takes to provide them!

What Is Chronic Care Management CPT 99490?

The CPT code 99490 is for chronic care management. It was introduced in the 2015 Medicare Physician Fee Schedule (MPFS) with its description reading as follows:

“Chronic Care Management services delivered via telephone by a physician or other qualified healthcare professional to an established patient within the last 12 months, 30 days prior to service being provided.”

What Does That Mean?

This chronic care management billing code is intended for physicians who provide ongoing care to a patient with conditions that require more frequent visits and monitoring. For example, if you have patients on dialysis or those requiring chemotherapy, then they may need your help managing their condition over the phone to ensure it remains well controlled between in-person visits.

Patients with chronic conditions such as diabetes, congestive heart failure, and asthma may also benefit from these services.

This code is not intended for just any use of the telephone with patients; it must be used in conjunction with one of your other CPT codes that require more frequent visits to justify CCM medical billing.

Who Should Bill For This Code?

Any physician who is qualified to provide the service and has a patient that they are billing for may bill this code. For example, you could be an internal medicine physician or primary care doctor who specializes in hypertension management and prescribing medication.

You would only use this CCM billing code if your practice had developed systems to monitor these patients over the phone between office visits so as not to be wasteful with your resources.

How Do You Bill For This Code?

According to CCM guidelines, to bill for this code, you will write the CPT 99490 in front of one of your other codes that require more frequent visits (99201-99215). So if you were billing Medicare, you would report 99490 after my E/M visit service.

How Often Can You Bill For It?

You can only bill for this code once per day. So, if you have a patient who needs multiple check-ins each day, you will want to bill it as a daily service, not per check-in.

Can You Bill For It With Any Other CPT Codes?

Yes. This code can be reported with any other Medicare or Medicaid-covered service that you provide to your patient. It is not limited to just office visits or any other specific medical services.

If you need assistance with your medical practice billing, allow us to help. At Sequence Health, we offer a wide range of solutions that can streamline your practices.

Want more assistance with CCM? Read about how practices can implement chronic care management.

Doctors are under a lot of pressure these days. You have to juggle seeing patients, staying up to date on the latest research, and practice within your state’s guidelines. On top of all of that, you have to think about healthcare reputation management.

This can be difficult because you’re always being watched by someone who might be a little too critical about what you’re doing wrong or getting right. However, with proper medical reputation management, you can ensure that your overall standing is strong.

What Is Reputation Management?

Reputation management for medical practices is essentially public relations for your brand. Given you aren’t a celebrity, you don’t really need a PR manager like someone in Hollywood would. However, you do need to exercise a certain level of control over your public image and that of your practice and work to make sure people are saying good things about you.

Another way to put this is that it is about building your brand. You want prospective patients to see your name or that of your practice and instantly feel a sense of trust in you. Medical online reputation management goes a long way towards making that happen.

Why You Should Care About Your Online Reputation

It is easy for doctors to assume that quality results and a kind demeanor are all that is needed to build a strong reputation. And not all that long ago, this was true. But now, your online healthcare reputation will reach prospective patients before you ever do.

A sloppy website, lack of information on Google, and just a couple of poor reviews without good ones to balance them can tank a career you’ve spent years trying to build. But, if you engage in medical practice reputation management, you can be seen as a genuine authority in your field, even if you’ve never headlined a conference or published your research.

As a medical professional, your reputation matters—and it matters, even more, when people are looking at reviews on Google or Yelp. Our team can help with everything from monitoring what is being said online to helping craft positive content that will endear your patients to you. At Sequence Health, we believe in protecting this most important asset; after all, who wants their livelihood impacted by an angry customer review they never saw coming? So don’t hesitate; contact us today.

Interested in patient engagement solutions? We can help you with everything from surveys to healthcare CRM.

As a doctor, you’re always looking for ways to reduce costs and have more time in your day. You work hard, long hours with few breaks. As a result, you need a qualified support team helping with all the tasks you can’t get to on your own—including medical insurance verification.

While you can give this task to your receptionist in charge of billing, this could mean paying for more hours or even hiring someone new just for insurance verification. A better solution, in most cases, is to contract with an insurance verification services company.

For a fraction of the cost, you’ll have access to top-notch insurance verification specialists, as well as other services that can make your practice run more smoothly.

But First, What Is a Medical Insurance Verification Specialist?

Medical insurance verification specialists are experts at clearing hurdles by quickly reviewing records, analyzing insurance plans, and verifying whether a patient has coverage or not so doctors can focus on healing instead of paperwork.

Medical insurance verification specialists also serve as a second set of eyes when it comes to making sure an insurer is paying benefits correctly, which helps make certain that health care providers get paid fairly for services rendered while protecting them from fraud schemes.

What Qualifications Do Medical Insurance Verification Specialists Have?

This can vary based on the company employing them. In general, all companies will look for the following qualifications:

• A high school diploma or GED.
• Previous billing experience.
• Knowledge of medical terminology.
• Experience with insurance companies.
• Clear communication skills and fluency in English.
• Detail-oriented focus.

Other companies will look for greater qualifications than this, such as a two-year college degree or greater, passing a certification exam, and completing a rigorous training program.

For those who are at the supervisor level, there is usually a requirement that they have a degree in healthcare management or business administration.

In this post, we’ve highlighted a bit about the role of a medical insurance verification specialist. If you want to learn more about how you can outsource your insurance verification, don’t hesitate to reach out!

We offer a wide variety of solutions that can help improve the quality of your practice while boosting your bottom line, including healthcare CRMs and call centers.

Not quite ready to outsource this task? Not a problem. Read up on how to verify medical insurance coverage on your own.

What is transitional care management?

Transitional care management is the set of services provided to a patient to help them transition from being in a hospital setting to reintegrating into the community. The period for transitional care management is defined as the 30 days following post-discharge.

The goal of TCM is to prevent hospital readmission. As of 2013, Medicare allows for billing of 30 days of TCM, this is an opportunity for providers to earn additional income from services they may already offer patients.

What is a transitional care unit?

A transitional care unit or TCU is a skilled nursing facility. Most TCUs are located either inside a hospital or a nursing home. Patients in a TCU have been discharged from a higher care level unit or a facility such as an Intensive Care Unit (ICU).

The TCU serves as a bridge between the higher care level unit and going home to a situation where there will likely be less assistance. As part of the TCU services, patients receive a discharge comprehensive plan and at-home follow-up.

What does CMS transitional care management look like?

To bill Medicare (CMS) for transitional care management, it is important to meet all five of their TCM components.

Initial Contact

The first step is for the qualified professional to contact the patient or their caregiver within the first two business days following the hospital discharge. The contact must be documented in detail to include the date and time of contact, the name of the person initiating the contact, how the contact was made, and a summary of the contact.

Medication Management

The qualified professional has the responsibility to document the medication given at discharge and to reconcile it with pre-hospitalization medication.

This medication management activity must be documented in detail to include both lists of medication, the qualifications of the reviewer, and the decisions made, if new medications were prescribed that list must also be included.

In-Person Visit

Within the first 7 days following the discharge, the qualified professional must visit the patient in person. The visit must be documented in detail.

Level of Decision-Making

TCM requires certain levels of decision-making for the 30 days following discharge. The medical decision-making varies from moderate to high complexity depending on the code.

Care Management Services That Do Not Require Face-to-Face Interactions

The requirements of this component are not as strict as the other ones, there is no set number of required interactions or a time requirement for giving these TCM services.

However, Medicare does have a list of services that must either be fulfilled by the qualified professional or clinical staff unless the services are determined not to be medically necessary. Again, this must be documented in detail.

To learn more about TCM, read: A Guide to Transitional Care Management.