Chronic Care Management: The Most Recent Entrant Into Palliative Care

The Centers for Medicare and Medicaid Services (CMS) has made changes to CPT 99490 in 2017 that may change the outlook of hospice care for both patients and providers for the better.

The changes are designed to make it easier for physicians to offer chronic care services for patients undergoing hospice and palliative care. CMS did this by making it easier for physicians to meet certain service and billing requirements and by introducing new billing codes.

Face-to-Face Initiating Visits

Enrolling patients in Chronic Care Management (CCM) is now easier because only new patients or those who have not seen the physician for one year are required to have a face to face initiating visit.

Communication Lines

The use of secure messaging services, the Internet and other asynchronous non-face-to-face communication lines is now allowed.

Consent of the Beneficiary

The provider can choose to obtain either a verbal or written consent from the patient as long as the provider documents the consent of the beneficiary in the medical records.

24-Hour Care

Now faxes are allowed to be used for transmittal of patient care information. This provides healthcare practitioners a faster and easier way to make contact with each other regarding urgent patient concerns.

Billing Services

The changes made in 2017 reduced the payment rules for billing of services. This was accomplished with new and updated CPT coding that greatly eased administration duties.

According to the needs of each patient, the three codes introduced by CPT 99490 allow payments from about $43 to over $141.

The HCPCS Code GO506 allows providers to bill for services provided outside of the usual face-to-face visits. It can be billed only once per each beneficiary but can be used in addition to the evaluation and management code.

However, hospice and chronic health care cannot both be billed for the same patient during the same service period. This recent CMS report states that, ".. Medicare does not allow CPT 99490 to be billed during the same service period as home health care supervision (HCPCS G0181), hospice care supervision (HCPCS G0182) or certain ESRD services (CPT 90951-90970) because care management is an integral part of all of these services." It does not appear that a hospice center would be precluded from submitting a claim for chronic health care services for a different service period. This is something a hospice provider may want to investigate further as more patients with multiple diagnoses are entering hospice programs and living for longer periods of time.

Concordance Healthcare Solutions is proud of our long-standing association with the hospice care industry and of our dedicated hospice program with products and services to support it. For more information on how we can support the needs of your hospice program please contact us to speak with one of our hospice specialists.

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