decisionhealth Newsletters, Coder Pink Sheets - 2019 Issue 10 (October)
CMS hopes eased reporting, new codes for care management will attract practices
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Article Overview
This article explains proposed CMS policy changes for care management services in the Medicare physician fee schedule. It is aimed at physicians, group practices, coders, billers, and practice managers who need to understand the scope of potential reporting and payment updates for chronic care management, transitional care management, and principal care management. The article focuses on proposed code restructuring, service-time requirements, and the general categories of services CMS may allow to be billed separately or with fewer restrictions.
Why This Topic Matters
The proposed changes could alter how practices document, report, and get paid for care management activities. Understanding the scope of the proposal is important for organizations that provide longitudinal care to Medicare patients and want to assess operational and reimbursement impact.
Article Sections
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Proposed: Principal care management
Introduces the proposed new principal care management framework and describes the general service concept, participating clinicians, and care coordination context.
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TCM the target of a pay raise
Summarizes proposed transitional care management payment and billing changes, including CMS discussion of services that may be treated differently under the proposal.
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‘Substantial’ revision to complex CCM
Covers proposed revisions to the complex chronic care management structure and the related changes CMS is considering for care plan requirements.
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More CCM time for clinical staff
Describes proposed adjustments to chronic care management time-based reporting for clinical staff and the related payment structure CMS is considering.
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Defining the newly proposed ‘principal’ care management
Provides an overview of the proposed principal care management concept and the broad clinical elements CMS associates with the service.
What You Will Learn
- How CMS is proposing to revise care management reporting under the Medicare physician fee schedule
- What broad categories of care management services are affected by the proposal
- Which types of practice workflows and service structures the article discusses
- How the article frames the relationship between chronic care management, transitional care management, and principal care management
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Health care administrators
- Specialists providing chronic care management
Codes Discussed
Code Ranges Discussed
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