decisionhealth Newsletters, Part B News - 2013 Issue 12 (December)
CMS: Some practices could miss out on new chronic care payment in 2015
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Article Overview
This article explains CMS’s chronic care management policy as described in the Medicare physician fee schedule final rule and why some practices may not be able to bill under the new payment approach. It is relevant to physician practices, care management staff, compliance professionals, and coders who track Medicare payment policy, CMS rulemaking, and the interaction between chronic care management, bundled payment models, and other care management services. The article also covers CMS’s discussion of the CPT and G-code framework, as well as several policy items deferred to future rulemaking.
Why This Topic Matters
The article highlights a new Medicare care management payment policy that could affect whether practices qualify to bill, what operational capabilities are expected, and how the policy interacts with other reimbursement models. Readers need this context to assess readiness for implementation and to understand which details remain unresolved in CMS guidance.
Article Sections
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Chronic care
Introduces the CMS chronic care management policy discussion and the main unresolved implementation issues tied to the 2015 payment timeline.
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ACOs may be out of luck
Discusses how participation in bundled-payment or coordinated-care programs may affect billing eligibility under the new policy.
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CMS maintains most requirements
Summarizes the broad service requirements CMS retained and the related practice capabilities discussed in the rule.
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Up in the air
Covers the policy topics CMS deferred for later rulemaking and the areas where further clarification was left pending.
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Signal to the AMA?
Reviews CMS’s references to CPT-based chronic care management coding and the broader implications for future code development.
What You Will Learn
- How CMS framed chronic care management in the 2015 Medicare physician fee schedule final rule
- Which broad practice capabilities and service components were discussed in the policy
- Why some care delivery settings may face billing limitations
- Which implementation topics CMS deferred to future rulemaking
- How CMS positioned the policy relative to CPT and G-code development
Who Should Read This
- Physician practices
- Medical coders
- Billing specialists
- Compliance professionals
- Practice administrators
- Health care attorneys
- Care management staff
Codes Discussed
Code Ranges Discussed
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