Medicare to Cover Multiple Chronic Disease Management in 2015

The final version of the 2014 Medicare physician fee schedule states that physicians seeing patients with two or more chronic conditions will be able to start collecting a separate fee from Medicare, excluding face-to-face visits.  However, CMS has not revealed what the requirements will be in order to collect the separate fee.  In the draft version of the 2014 fee schedule, CMS disclosed the conditions for the chronic care management (CCM) fee, which included the use of a certified electronic health record (EHR) system, employment of at least one nurse practitioner or a physician assistant, status as a medical home, and offering CCM services around the clock.

The fee applies to patients with multiple chronic conditions that they’re likely to endure for at least 12 months or until death; the conditions must also put them “at significant risk of death, acute exacerbation/decompensation, or functional decline.”  Although CMS currently does reimburse physicians for conditions that may quality for CCM, CMS acknowledges that physicians often do more work than what E/M rates reflect.

Physicians will be able to bill Medicare using a new “G-code,” which they can apply to 20 minutes of CCM services over 30 days.

For more information from The Remington Report, click here.

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