Chronic conditions affect 117 million people with 1 in 4 Americans having 2 or more chronic conditions. Safety-net providers see many patients with chronic conditions for their routine and specialized needs relating to their chronic conditions. Did you know a staggering 99% of all Medicare spending is on patients with chronic conditions?¹ This is a major reason the Centers for Medicare & Medicaid Services (CMS) are offering additional reimbursement opportunities for Chronic Care Management (CCM).
We believe that the use of digital technologies that provide either one-way or two-way data between MIPS eligible clinicians and patients is valuable, including for the purposes of promoting patient self-management, enabling remote monitoring, and detecting early indicators of treatment failure. – CMS
CCM is a Medicare reimbursement program for beneficiaries with multiple chronic conditions. Eligible beneficiaries include patients with 2 or more chronic conditions expected to last at least 12 months. The FQHC payment code is G0511 for a monthly $67 reimbursement, per patient, when 20 minutes of clinical staff time is spent on non-face-to-face care coordination.
Note that this non-face-to-face time can be provided by clinical staff members, including external care managers. “Incident to” the services of the supervising (billing) practitioner, general supervision, can also be included.
This is a great opportunity for safety-net providers and their patients but there are barriers to entry if a CCM program isn’t already in place. You must ensure proper documentation, tracking time, define internal CCM program workflows with your staff, and ensure all this information is audit-ready.
Behavioral Health Integration (BHI) Services are very similar to CCM except that eligible beneficiaries are patients with any mental, behavioral health, or psychiatric condition being treated by the billing practitioner. BHI is a Medicare reimbursement program for beneficiaries with the billing code of G0511–a monthly $67 reimbursement, with at least 20 minutes of a behavioral health care manager or clinical staff time being applied to care coordination. Note the differences from CMS:
CCM involves care planning for all health issues and includes systems to ensure receipt of all recommended preventive services, whereas BHI care planning focuses on individuals with behavioral health issues, systematic care management using validated rating scales (when applicable), and does not focus on preventive