Chronic care management programs billed under CPT® code 99490, which reimburses about $40* for each monthly non-face-to-face care interaction with Medicare beneficiaries with two or more chronic illnesses, must begin with a face-to-face session. At this session, eligible patients must sign a consent form, which, among other things, obligates them to their co-pay portion of the reimbursement, or about $8 per month.

CMS and a Congressional committee are currently reviewing changes to the chronic care management program. These changes could possibly alter the program’s copayment structure. Until then, you can continue to sign up patients by engaging them in an enrollment conversation.

Enrollment Conversation: The $8 Stumbling Block

While $8 per month is not a huge sum, it is often a stumbling block for many programs. Patients will want to know what they will get for their money, and you need to be prepared.

You must have a structured, well-planned enrollment conversation that educates patients on the chronic care management program—and helps alleviate their concerns. Depending on your practice’s workflow and relationship with the patient, any clinical staff member can conduct the session and obtain the patient’s written consent.

Here are a few program features to emphasize in your enrollment conversations:
  1. The program provides a monthly connection to the physician practice, during which physical, mental, cognitive, psychosocial, functional and environmental inputs can be added to the care plan.
  2. The patient’s primary contact during the non-face-to-face sessions will be a nurse.
  3. Patient and nurse can review medication adherence and potential interactions.
  4. One program goal is to avoid more costly face-to-face interventions (i.e., emergency room visits) through increased prevention and patient involvement.
  5. Program staff can help the patient navigate the greater healthcare continuum by providing care coordination with varied social services, managing manage care transitions and facilitating referrals.
  6. The patient has the ability to revoke participation in the program at any time. It may take a little salesmanship to “close the deal.” However, if you stay true to the patient benefits, signatures may likely follow.

Learn more about web2pro Chronic Care Management ServicesTM

*$40 per month is the national average, according to the 2015 Medicare PFS. Actual amounts will vary by region.
CPT® is registered trademark of the American Medical Association

Bill Sillar

About the author

Bill Sillar is National Channel Manager for web2pro Business Performance Services, supporting web2pro’s value-based care services. Sillar has been with web2pro for 10+ years and has played a pivotal role in helping healthcare organizations bridge the gap as they transition from a fee-for-service to a value-based reimbursement payment model.