Medicare Gives Details on Care Coordination Pay

Abstract

Starting Jan. 1, 2015, Medicare will pay physicians about $42 for certain care management (CCM) services outside of the face-to-face office visit, according to a new government proposal. The proposed rule (s3.amazonaws.com/public-inspection.federalregister.gov/2014-15948.pdf) for the 2015 Medicare Physician Fee Schedule, released in July, offers details on how officials at the Centers for Medicare & Medicaid Services (CMS) plan to roll out the new CCM services payments that begin next year. The proposal also expands telehealth services offered by Medicare and makes changes to the Open Payments program. CMS proposes to pay $41.92 for a new G-code for chronic care management services provided to patients with two or more chronic conditions that are expected to last at least a year. The code could be billed only once a month for each patient. To bill for the code, physicians would have to offer some type of 24/7 access, continuity of care, care management for chronic conditions including medication reconciliation, creation of a patient-centered care plan, management of care transitions including visits to the hospital and emergency department, and coordination with community-based services. According to Dr. Charles Crecelius, CMD, chair of AMDA's Public Policy Committee and a past AMDA president, CMS has taken the value code proposed by the Relative Value Update Committee, a multispecialty CMS advisory panel, and tweaked it by substantially decreasing the staff scope of practice and other burdensome requirements and also by decreasing the level of proposed reimbursement. “AMDA has participated in the development of the CCM code since its inception,” he said. “Whether the reimbursement will truly provide adequate reimbursement given the level of documentation required remains to be seen. This code only applies to the outpatient codes, which many of our members use.” In the 2015 Physician Fee Schedule, CMS is also proposing to require that physicians use certified electronic health record technology. The American Academy of Family Physicians (AAFP), a group whose members will benefit from the coding change, applauded CMS for introducing the care management code. But they said the benefit of the code would be overshadowed if Congress allows the scheduled cut to the Medicare sustainable growth rate (SGR) formula to go into effect on April 1. The fee schedule proposal reiterates that physicians will face a 20.9% across-the-board fee cut next year if Congress does not repeal or postpone the SGR. “The AAFP welcomes the new code, but we also look to a day when policies designed to strengthen primary medical care are not undermined by drastic cuts to the underlying foundation on which all payment is based,” Dr. Reid Blackwelder, AAFP president, said in a statement (www.aafp.org/media-center/releases-statements/all/2014/statement-medicare-physician-fee-schedule.html). The proposed fee schedule also seeks to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to the list of telehealth services that can be furnished to Medicare beneficiaries under the telehealth benefit. Medicare also proposes to eliminate the coinsurance payment on the anesthesia portion of a screening colonoscopy when it is provided separately by an anesthesiologist.