In 2016, the Centers for Medicare & Medicaid Services (CMS) began reimbursing for advance care planning (ACP) as a payable service for traditional Medicare beneficiaries. ACP is the face-to- face time a physician or other qualified health care professional spends with a patient, family member, or surrogate to explain and discuss advance directives. Two CPT codes are used to report ACP services: 99497 and 99498.
The America Academy of Family Physician’s Position on ACP
The Academy’s advocacy efforts helped pave the way for ACP payment. We supported the creation of CPT codes for ACP and applauded their inclusion in the 2016 Medicare physician fee schedule. Medicare reimbursement for ACP gives family physicians an opportunity to be paid for the time they commit to conversations with their patients about end-of- life decisions.
On behalf of members, the Academy is continuing to advocate with private payers for full and fair reimbursementof care management services through monthly care management fees. We are also pushing private payers to make care management programs transparent to both physicians and patients.
Getting Reimbursed for End-of- Life Planning Conversations
Discussing end-of- life decisions with your patients and their families can be difficult and uncomfortable, but as a patient's primary care provider, family physicians are ideally suited to facilitate this conversation.
What is an Annual Wellness Visit?
Medicare covers an annual wellness visit with no cost to the patient whether they are enrolled in original Medicare or a Medicare Advantage plan, as long as, the practice is an in-network provider. This visit is an opportunity for patient and the Practice’s My Constant Care Wellness team to develop a personalized prevention plan that takes a comprehensive approach to improving health and preventing disease.
The annual wellness visit benefit includes the following services:
Routine measurements, such as your height, weight, blood pressure, and body mass index (BMI);
Review of the patient’s medical and family history
Review of the medications, supplements, and vitamins that the patients are currently taking;
Discussion of the care the patient’s are currently receiving from other health care providers;
Review of functional ability and level of safety (for example, their risk of falling at home), including any cognitive impairment, as well as a screening for depression;
Discussion of personalized health advice that takes into account the patient’s risk factors and specific health conditions or needs, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition;
Discussion of referrals to other appropriate health education or preventive counseling services that may help the patient minimize or treat potential health risks;
Creating a Care plan with an action plan that will be utilized throughout the year for improvement
Planning a schedule for the Medicare screening and preventive services the patient will need over the next five to 10 years.
Why Outsource the Annual Wellness Visit?
The workload required for the Annual Wellness Visit has been a challenge by many fellow practices. The ability to
spend 60 minutes per patient is quite cumbersome. Outsourcing services such as Annual Wellness Visits allows physicians to offer their patients the preventive care Medicare allows without the added effort. Qualified Nurses and Certified Medical Assistants meet with your patients on a yearly basis, acting as an extension of your practice and providing personalized care to your patients according to your specifications.
What is Chronic Care Management? (CCM)
Recognizing the value Chronic Care Management (CCM) can deliver in improving health outcomes and reducing healthcare spending, the Centers for Medicare and Medicaid Services (CMS) adopted a new service code in January 2015. CPT Code 99490 reimburses physicians or other eligible healthcare professionals approximately $43 per patient per month (national average as of January 2018) for delivering at least 20 minutes of non-face- to-face care coordination to eligible Medicare beneficiaries, with the following required elements:
How can My Constant Care support my Chronic Care Management program?
As an established leader in the healthcare marketplace for software solutions that work, My Constant Care combines easy-to- use technology and 24/7/365 clinical services for healthcare organizations looking to outsource their CCM program. Our Wellness Coordinators, Registered Nurses, perform the required monthly services so your patients receive individualized care plans, help with scheduling upcoming visits to your office or specialist which in turn help you close the necessary gaps in care. We will help you provide value-based care while earning monthly recurring revenue and meeting your MACRA requirements for ongoing reimbursement for years to come.
My Constant Care exceeds Medicare’s requirements for CCM with action-oriented goals for your patients and follow through for other Preventive services performed for proper billing of CPT 99490. We also support practices in maximizing the opportunities afforded by new complex CCM codes 99487 and 99489, and add-on code G0506. Complex care patients take up more of your valuable time, you should be getting paid for the additional work required.