Care Management in 2020:

Each year, CMS makes updates to the Medicare care management programs to create more financial reimbursement opportunities for providers and improve the health outcomes of their patients. This year's final rule for the Physician Fee Schedule contains modifications to payment rates, payment policies, and quality provisions. These updates will be officially implemented on January 1, 2020.

TCM Program Updates:

Transitional Care Management focuses on reducing unnecessary hospital readmissions of patients in care transitions from hospital to home through better coordination of care and follow up during the 30 days post-discharge.

2020 TCM Billing Modifications:

To incentivize higher utilization of the currently under utilized TCM program, the CMS will increase the RVU rates for CPT codes 99495 and 99496. In addition to this, the CMS will now allow for the concurrent billing of 14 previously restricted codes. Both modifications encourage higher TCM implementation among providers.

CCM Program Updates:

Chronic Care Management (CCM) is recognized by CMS as a critical component of primary care that contributes to improved health and care for beneficiaries. The goal of the program is to reduce unnecessary ER visits and hospitalizations by helping patients better manage their conditions through increased communication, education and coordination of care between office visits.

2020 CCM Code Modifications:

CMS has developed a new code to reimburse clinicians providing time beyond the initial 20 minutes allowed in the current coding for CCM services. In addition to this, a new policy will be implemented to allow for a single consent for communication-technology-based services. The current program requires that the provider obtains consent with each interaction. The aim of the new CCM code is to provide further reimbursement to those providers going beyond to provide a higher quality of care. The new policy for single consent aims to simplify current program requirements.

PCM Program Updates:

Patients eligible for Chronic Care Management (CCM) services must have two or more chronic conditions expected to last at least 12 months that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. However, this year the CMS has finalized two Principal Care Management Codes (PCM) that addresses beneficiaries who don't meet this specific criteria.

2020 PCM Introduction:

The PCM Program recognizes that many Medicare beneficiaries may have only one serious and high-risk condition. CMS is aware that clinicians are currently managing this type of patient, but are not receiving financial reimbursement. The formation of these two codes will provide improved care for those patients who don't meet the CCM criteria due to only having one chronic condition.

Summary:

The CMS continues to modify its care management programs yearly, in an effort to improve patient outcomes and reward physicians for providing better coordination of care during and between office visits. The 2020 updates to the Physician Fee Schedule continue to encourage providers and organizations to benefit from fee for service care while transitioning to value based care.