Care managed: CMS aims for changes that will close gaps in patient care

Why This Topic Matters

Care management services are a recurring source of billing and compliance questions, and CMS policy changes can affect payment, reporting workflows, and which practices use these services. This article helps readers track the broader Medicare direction for care coordination and understand why the changes matter to primary care and specialty practices alike.

Article Sections

1. CMS final rule overview

   Introduces the Medicare physician fee schedule changes affecting care management services and explains the general policy context. It frames the discussion around chronic care, principal care management, and transitional care management.

2. Chronic care management updates

   Covers Medicare’s position on chronic care management code set changes and related implementation timing. The section also addresses reporting considerations for established chronic care management services.

3. Principal care management implementation

   Describes the new principal care management service structure and the type of practitioners and scenarios the policy is intended to address. It also notes CMS expectations about how the service may be reported.

4. Transitional care management payment changes

   Summarizes the Medicare payment updates associated with transitional care management services for the coming year. It places those changes in the context of CMS efforts to address utilization gaps.

5. Concurrent billing policy changes

   Explains the final-rule policy permitting certain care management services to be billed together during the same time period. It also notes CMS commentary on how this could affect future editorial review.