Medicare Will Pay Docs For Multiple Chronic Disease Management

With this news physicians and multispecialty practices can and should understand the cost structures and make sure the coding capabilities of the billing systems are updates p.r.n

Starting in 2015, physicians can collect a separate fee from Medicare for managing patients with two or more chronic conditions apart from face-to-face visits, according to the final version of the 2014 Medicare physician fee schedule that the government released last week.

The new fee is good news for primary care physicians, but the Centers for Medicare & Medicaid Services (CMS) has yet to spell out all the requirements for earning the extra money. When CMS unveiled the chronic care management (CCM) fee in a draft version of the 2014 fee schedule this summer, it laid out conditions that struck organized medicine as unnecessary and onerous. These included the use of a certified electronic health record (EHR) system, employment of at least one nurse practitioner (NP) or physician assistant (PA), status as a medical home, and offering CCM services on a 24/7 basis.

In the 2014 fee schedule, CMS states that it will address physician objections to the requirements for medical-home status, a certified EHR system, and the employment of NPs and PAs in future regulations. So the government punted on those points of contention.

However, CMS rejected suggestions to relax or phase in its original proposal of making CCM services available 24/7. The new fee applies to CCM services for patients with multiple chronic conditions expected to persist for at least 12 months or until death, and the conditions must put them “at significant risk of death, acute exacerbation/decompensation, or functional decline.” CCM services include treating acute problems such as a fever, drafting a care plan, making referrals to other physicians, and collaborating with home-care agencies.