CCM and TCM: It's a Win/Win

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Description

During this webcast, we addressed the Chronic Care Management and Transitional Care Management programs and the criteria needed to bill for them. We focused mostly on CCM Care Plans and Follow Up and the documentation required to substantiate using the CPT Code 99490.


Webcast Materials

Presented 12/9/2015


Presentation Slides


Q&A

Question: Is there regulation on who can initiate the care plans with a patient? Does it have to be a RN?

Answer: Ultimately the provider has to sign/approve the care plan per guidelines. However, clinical staff/RN may add content but the care plan has ot be managed by a MD, DO, NP or PA.

Question: Does time spent need to be documented on the care plan?

Answer: The time spent is documented on the follow up note not the care plan to track the non-face to face time. We'll review in detail doing the Q/A. The care plan is to be completed/signed/reviewed by the provider.

Question: 3 items were mentioned as pre-requisites to billing for CCM -- annual wellness, consent, and ???? - what was the 3rd?

Answer: Pre-requisites to billing: Patient Consent, Initiated from Annual or Initial Exam (AWV or IPPE) or comprehensive E/M visit, Care plan, Certified EHR, 24 access, completed 20 minutes of non-face-to-face time.

Question: We are partnering with MD RevUp to implement our CCM program and are STRUGGLING with automation and interfacing from their system to our system. We are practically manually billing. How can Allscripts or MediTech help us with this?

Answer: Allscripts and Meditech are Electronic Health Records that we referenced during our call today. Galen Healthcare Solutions has developed workflows, program development, automation aspects regarding them specifically. Our services include both technical, product, and professional services to support clients during a CCM implementation.

Question: Does Galen work with Cerner Millennium EHR?¬ Q: ¬We started May 2015 and have yet to obtain automation in our PRODUCTION domain

Answer: We have assisted clients on a variety of Electronic Health Records. Personally, having worked for 2 different EHR vendors, I find most of them are fairly similar in design. Galen has designated resources within Allscripts, Meditech,and Epic verticals. With that said, I’d love the opportunity to have an initial call to see if we can assist your organization as our technical and professional service teams can do magic. Our technical team has worked with a number of vendors from a conversion aspects including Cerner so the basic concepts are intact and likely we can assist with any integration issues and assist your team in supporting the implementation.

Question: Both the testing of CCM build and end user training is consuming our human resources

Answer: I completely understand as a project/program manager it can be very difficult to get programs implemented. Our team can certainly assist with testing/training if that is something that would help you and your organization.

Question: Can Galen Consulting send me a SAMPLE project plan for your consulting services?

Answer: I always hate to lead with a question to answer a question but are you looking for a project plan to roll out or a check list for success. I’m happy to provide a sample CCM project plan for items to consider if trying to implement a new program is that helps.

Question: When you gave the example about the patient who went back into the hospital for Lipitor. You stated that you cannot bill for the CCM code if they have home healthcare, admitted to hospital and hospice? Correct?

Answer: Yes that is correct.

Question: Someone mentioned that when CCM is billed within a month, the patient CANNOT have admissions in that billing month for Inpatient Admission, Home Health admission, and Hospice admission.

Answer: Yes that is correct.

Question: Can you share with me the guideline that states the provider has to sign/approve or initiate the care plan? The documentation i have just discusses a comprehensive care plan but not who is responsible for it.

Answer: You are correct in that there is nothing in the CMS documentation that says it HAS to be a provider. However, I ultimately envision the provider has to sign/approve the care plan per guidelines. However, clinical staff/RN may add content but the care plan has to be managed by a MD, DO, NP or PA. You’ll see in the attached CMS guidelines it isn’t clear however it does need to be tied to an E/M visit where CCM is discussed and I don’t see this as in scope for most RN’s to complete the entire care plan for a chronic disease but perhaps a combined effort where some of the information is entered by clinical staff and some of it from the provider with final decision making completed by the provider. Also given the “incident to” billing concept in most states I don’t see where the care plan development and defining the scope of the patient goals would fall into their scope but it would depend on the state regulations.

Question: What was the name of the tool that tracks time in V11?

Answer: It is our noteform reporting tool

Question: When is the best time during the month to bill 99490? As sson as the 20-minutes is met or waiting till the end of the month?

Answer: Would recommend waiting until the end of the month to ensure the patient was not hospitalized, put on hospice or provided with home health services.

Question: When you gave the example about the patient who went back into the hospital for Lipitor. You stated that you cannot bill for the CCM code if they have home healthcare, admitted to hospital and hospice?

Answer: Correct: CPT 99490 for CCM services cannot be billed with any of the following services in the same month: Hospital Admission, TCM codes (99495 or 00496), home health supervision or hospice care (G0181/G0182), or End Stage Renal Services (90951-90970).

Question: Can you provide again what specifically needs to be included in the documentation?

Answer: ¬Can you provide again what specifically needs to be included in the documentation o Record the patient’s demographics, problems, medications, and medication allergies and create structured clinical summary records using certified EHR technology. o Care plan to include: A comprehensive care plan for all health issues typically includes, but is not limited to, the following elements: o Problem list; o Expected outcome and prognosis; o Measurable treatment goals; o Symptom management; o Planned interventions and identification of the individuals responsible for each intervention; o Medication management; o Community/social services ordered; o A description of how services of agencies and specialists outside the practice will be directed/coordinated; and o Schedule for periodic review and, when applicable, revision of the care plan. o Documentation of 20 minute non-face-to-face time


Question: Follow up on Homecare admission. Is this a new admission for that month or if a patient has existing homecare

Answer:Any admission to home health care would make it not eligible that month to bill for CCM CPT 9940 code.