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Chronic Care Management and Virtual Communication Services Billing
Carolina Medical Home Network
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Chronic Care Management
What patients are eligible? Who Can Perform CCM? What Services are eligible for CCM? Pre-Requisites for CCM Billing CCM Chronic Care Management
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Medicare Patients with two or more chronic conditions that are expected to last 12 months or until the death of the patient. The chronic condition places the patient at risk for death, acute exacerbations, decompensation or functional decline. CCM Eligibility
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Who can perform CCM? MD NP PA CNS CNM
Clinical Staff of the Eligible Providers The Eligible Providers provide oversight to their clinical staff. There is supervision, but it is not required that the clinical staff and Eligible Provider are in the same physical location. Who can perform CCM?
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What Services are Eligible for CCM?
Continuity of Care Care Management and Care Planning Transitional Care Management (TCM) Coordination with Home and Community based clinical service providers 24/7 Access to urgent needs Enhanced communication (i.e. ) EMR documentation of demographics, problems, medications, and allergies in a Certified EMR What Services are Eligible for CCM?
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An Initiating Visit must occur for new patients or patients not seen within a year of initiating CCM services (i.e. AWV, IPPE, TCM or E/M) CCM consent does not have to be discussed or obtained during the initiating visit. A certified EMR must be used to document standardized information for core clinical information (demographics, problem lists, medications lists, and allergies) Documentation for CCM elements (i.e. Care Plan) or TCM not required to occur in a certified EMR Verbal consent must be obtained and documented in the EMR prior to commencing CCM services Only required once Must Discuss: Availability of services and cost sharing Notification that only one provider can provide CCM services per month Notification that the patient can stop services at any time Approval for the provider to consult with specialty providers Pre-Requisites
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Billing FQHCs and RHCs must use the HCPCS code G0511
An appropriate ICD code must accompany the claim Code can be billed alone or with other FQHC payable services Both services will be paid Rate for G0511 is $67.03 per month per patient for 20+ minutes of qualifying services The date for billing can be the date the requirements are met or a later date prior to the end of the month Complex CCM is not payable to FQHCs or RHCs Visit is cost shared with the patient and co-insurance and deductibles are applied Cost sharing cannot be waived for the patient Financial Assistance can be offered Cannot be billed during the 30-day TCM service period Billing
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Virtual Communication Services
What are Virtual Communication Services? What communication qualifies? Who can provide the services? Pre-Requisites Billing Virtual Communication Services
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Virtual Communication Services
Eligible Providers provide remote evaluation of patients using technology based communication. Considered a brief discussion to determine if a visit is necessary Must be 5+ Minutes The medical discussion cannot be related to a FQHC service provided in the previous 7-days The medical discussion cannot lead to a visit within the next 24- hours or next available appointment Must be initiated by the patient Providers following up with patients about their condition are not eligible services Virtual Communication Services
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What type of Communication Qualifies?
Telehealth services are not the same as VCS. Telehealth services are considered a substitute for in in-person visit and are considered a FQHC visit Telephone Calls, integrated audio/video systems, store and forward method such as sending a picture or video to the eligible provider initiated by the patient are eligible The eligible provider may respond using the telephone, audio/video, secure text messaging, , or the patient portal What type of Communication Qualifies?
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Who can provide VCS? MD NP PA CNW Clinical Psychologists
Clinical Social Workers Support Staff do not qualify Who can provide VCS?
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Patient must have had a FQHC or RHC billable visit within the previous year
Consent should be obtained and documented in the medical record Pre-Requisites
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Billing FQHCs and RHCs must use the HCPCS code G0071 for billing
Rate for G0071 is $13.69 and can be billed as frequently as needed for the patient (There are no frequency limitations at this time) Visit is cost shared with the patient and co-insurance and deductibles are applied Cost sharing cannot be waived for the patient Financial Assistance can be offered VCS cannot be billed for related services for a visit within 7-days and cannot results in a visit within 24-hours VCS can be billed alone or in conjunction with CCM or on the same claim as a billable visit (*Note Restrictions Above) Billing
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https://www.cms.gov/Center/Provider-Type/Rural-Health-Clinics- Center.html
Health-Centers-FQHC-Center.html Payment/PhysicianFeeSched/PFS-Federal-Regulation- Notices.html Resources
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