CMS released the proposed reimbursement for the new chronic disease management G-code set to take effect in 2015. This is excellent news for primary care physicians that typically bear the brunt of the responsibilities required in chronic care management.
Physicians would receive a monthly payment of $41.92 for managing a patient with two or more chronic diseases outside of face-to-face office visits.
This would compensate physicians for tasks such as developing a care plan, referring patients to colleagues, and working with home-care agencies.
Physicians would bill Medicare for chronic-care management using the new G-code if the following criteria are met:
20 minutes of management services over 30 days.
The patient’s multiple chronic conditions are expected to last at least 12 months, or until death.
The conditions represent a significant risk for death, functional decline, or acute exacerbation or decompensation.
Chronic-care services must be available on a 24/7 basis, but a clinical staff member can provide them at the midnight hour on an "incident-to" billing basis without direct supervision.
The 2014 draft version proposed criteria also included the use of a certified electronic health record (EHR) system, employment of at least one nurse practitioner (NP) or physician assistant (PA), status as a medical home. These requirements have been removed from the 2015 proposed fee schedule.
Besides making reimbursements a little more “fair” for providers, another impetus for the increased focus on chronic care management is overall care cost reductions.
Based on 2010 data of Medicare fee-for-service beneficiaries with 15 major chronic illnesses such as hypertension, hyperlipidemia, and ischemic heart disease, the agency found that seniors with 4 or more conditions accounted for 37% of all beneficiaries, but 74% of total Medicare spending.
This is another way how CMS has been ramping up efforts across the board to improve patient care while reducing costs. This is definitely a win-win situation.