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...

CMS Care Management Programs - History and Overview:

In 2013, CMS introduced Transition of Care Management (TCM), reimbursing providers for furnishing care to patients transitioning from the hospital to their home. Two years later, the Chronic Care Management (CCM) program was launched to promote better outcomes and reduce the cost of care for patients living with two or more chronic conditions. To expand on the established Annual Wellness Visit (AWV) benefit, CMS introduced Advanced Care...

TCD Medical and Behavioral Health Integration:

An estimated one third of patients being treated by a primary care doctor are also suffering from a mental health condition or substance abuse disorder. Primary care doctors may feel overwhelmed, or that their practice is not equipped to handle such specialized care. However, due to limited access issues, it may take three to sixth months to make an appointment with a behavioral health specialist. A partner of Avicenna, the Amherst-based TCD Medical

Behavioral Health Integration Program:

Behavioral health integration (BHI) was added to Medicare’s care management programs in January 2017, reimbursing physicians and non-physicians for BHI services provided to patients with mental, behavioral, or psychiatric conditions. Since the introduction of BHI, Medicare has continued to update the billing codes and expand the reimbursement opportunities for providers aiding the millions of Americans living with a mental health disorder.

Medicare's...

Updates for Medicare Diabetes Prevention Program Expanded Model:

With the intent of lowering the rate of progression to Type II diabetes and improving overall health, the CMS has finalized the Medicare Diabetes Prevention Program (MDPP) expanded model, which will allow qualified providers to begin furnishing MDPP services this year.

Care Management Programs Overview:

Beginning in 2013, the Centers for Medicare and Medicaid Services introduced transition of care management (TCM), reimbursing providers for helping their patients with the transition from hospital to home.  Following the introduction of TCM; in 2015 CMS introduced the original chronic care management code, CPT code 99490, to pay providers for delivering non-face-to-face care to Medicare patients with two or more chronic conditions.

In 2017 CMS enhanced the CCM...