The value of gaining experience and proficiency with population management and value-based reimbursement (VBR) is becoming essential as Medicare shifts a greater portion of its payments to these methodologies. This opportunity allows practices to get paid while learning about this new shift and gaining confidence and competence with VBR.

In January 2015, the Centers for Medicare & Medicaid Services (CMS) began reimbursing clinicians for providing oversight and care coordination (i.e., non-face-to-face care) to Medicare’s sickest beneficiaries. The new reimbursement code reflects an acknowledgment by CMS that compensation for the chronic care management (CCM) duties central to new delivery models like accountable care aren’t included in traditional fee-for-service payments. At the same time, the move marks a critical first step in the long journey toward restructuring the most expensive and arguably the most disjointed segment of healthcare.

For some clinicians, the new chronic care code (CPT code 99490) creates an opportunity to generate revenue for services already being performed. With a reimbursement rate of approximately $40 per enrollee per month, the new code could potentially produce an additional $100,000 annually for a physician caring for 200 qualified patients.1

The primary care physicians who pursue Medicare CCM reimbursement must decide whether to rely on internal staff to execute the many clinical support duties associated with the code or turn these over to a qualified outsource vendor. Each approach has benefits. However, the decision may ultimately turn on the extent to which a practice has the internal capability to consistently perform the code’s reimbursement requirements.

For more details about managing chronic illness among Medicare beneficiaries, chronic care management program compliance requirements, and evaluating in-house vs. outsourced programs, view the McKesson white paper “Chronic Care Management Offers Enhanced Quality Care and Additional Revenue.” (PDF, 78 KB)

1Samuel T. Edwards, Bruce E. Landon, “Medicare’s Chronic Care Management Payment – Physician Reform for Primary Care,” New England Journal of Medicine, Nov. 27, 2014.

McKesson

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McKesson Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.