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What is Chronic Care Management CPT 99490?

New CPT code 99490

⇒ The Service
⇒ The Access to them and their family members to their data
⇒ By a range of certified clinical staff or allied health professionals
⇒ The Data sharing
⇒ The Cost sharing (CO-PAY of $8)
⇒ Option of revocation of consent

Who can bill CPT 99490?

Any physician can bill and provide CCM service to a patient. Do note, only one physician can bill for CCM server per month for a patient.

What are the requirements for CPT 99490

1. Get Consent Forms signed by patients detailing the below.

⇒ The Service
⇒ The Access to them and their family members to their data
⇒ By a range of certified clinical staff or allied health professionals
⇒ The Data sharing
⇒ The Cost sharing (CO-PAY of $8)
⇒ Option of revocation of consent

2. Create comprehensive individual care plan
3. Provide 24x7 access to care management services
4. Certified Care Management System

⇒ Certified technology required for some services:
⇒ Structured data recording
⇒ Documenting provision of care plan to beneficiary
⇒ Formatting clinical summaries
⇒ Documenting communications with home and community based providers

5. Provide 20 min of non face-to-face care management to the patient per calendar month

I have a small practice, how can I offer 24/7 access?

ChronicWatch provides turnkey solution where you just refer the patient to us and we provide complete end-to-end solution. No upfront costs or ongoing costs. You keep your patients happy and you make money.

What are the different options you provide to address CPT 99490?

We have 2 options:

⇒ Turnkey solution: A complete turnkey solution where we do all the work including a 24/7 clinical triage as well as all technological upgrades.
⇒ We provide only the technology and you do all the 24/7 clinical triage.

How does this work; can you please detail the steps?

Patient: Walks to his regularly scheduled clinical appointment.

Physician: Recommends annual wellness visit or initial preventative physical exam and then after the visit recommends CCM program to eligible patients and obtains consent for CCM program including $8 co-pay. Physician refers to care management team of ChronicWatch (fax, email, phone) at point of care. ChronicWatch Care team member:

⇒ Enrolls the patient.
⇒ Initial CCM call initiated, patient assessed, care plan established in ChronicWatch software.
⇒ Welcome packet including care plan provided to patient after initial call.
⇒ Does Medication reconciliation, Care planning, Depression screening, Patient education, Additional resource needs like ambulance, etc.

ChronicWatch Nurses: Provide ongoing 20 mins of non-face-to-face services to include the above in addition to Making referrals, Setting up services, and Refilling medications
ChronicWatch Medical Billing Team: Sends the invoice to Physician's billing office.
Physicians Medical Billing office: Sends the claim to Medicare and pays ChronicWatch.

What patients or chronic conditions are eligible?

CMS has left the ruling open to the discernment of the provider. The guideline simply requires: Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation. What providers are eligible?

When can the patient be enrolled?

CMS requires the billing practitioner to furnish an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), or comprehensive evaluation and management visit to the patient prior to billing the CCM service, and to initiate the CCM service as part of this exam/visit. CCM can be billed for this first month if the consent form is signed and the required elements are performed.

Is your technology HIPAA-compliant?

Of course! Everyone on the ChronicWatch team has signed the required HIPAA agreements as well.

What types of patients & care delivery systems are excluded?

Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) may not participate, unless they have approval to bill non-RHC or non-FQHC services.

Is my patient responsible for any payment?

As applicable by any other billable code, the patient is responsible for deductibles, co-payments, and remainder amounts according to the patient's insurance agreement. 99490 is not an exempt/or is not exempted from cost-sharing rules unfortunately, so Medicare Part B patients with no secondary coverage will be responsible for about $8/month. The intent of the code is to reduce costs for all parties including the patient. Better coordination means fewer visits, which in turn reduces the patient's overall out-of-pocket expenses.

I want to only use the software and my practice will provide 24/7 clinical support. How does it work?

You only pay for the software when you use it to deliver chronic care management (CCM) services to one of your enrolled beneficiaries. We charge a per-patient, per-month fee for each patient for each completed month of chronic care management service. We track your transactions and generate a detailed report that you can access via the web 24/7. You are invoiced at the end of the calendar month.

Are there any setup costs?

No.

Is there any software to install?

No. ChronicWatch is a cloud-based software available on computers, android and IOS phones. We can set up your own password-protected site within two business days. You should be able to offer care management services the moment your staff is trained.

How much does the training cost?

Nothing. We offer comprehensive web-based training by a registered nurse every month. We can get your staff competent on the system in less than 48 hours.

How do I get the care management note into my EMR?

ChronicWatch will send Direct Email and the patient's information will be automatically populated into your EHR.