2022 Medicare CCM Payment Rises and What Is the Next Generation CCM?


By Scott Rice, MD, PhD, MBA, MS, and Richard Grosso

The 2022 Medicare Physician Fee Schedule Final Rule announced substantial increases in payments for Medicare Chronic Care Management (CCM), although most other services will receive about 4% less than in 2021. increases encourage greater participation in the CCM with a reimbursement for the minimum billable CCM. services, at least 20 minutes of telephone contact (CPT 99490), rising from an average of $ 42.17 to $ 62.16, an increase of 51%! With this new reimbursement, a practice that recruits 300 Medicare-eligible patients has the potential to generate more than $ 225,000 in annual CCM revenue. Creating such a profitable new source of revenue helps offset the negative financial effects of disruptions and reductions in payment that contribute to loss of satisfaction and physician burnout.

Richard Grosso

Historically, the ACA has mandated in 2010 the provision of care coordination and disease management services to Medicare and Medicaid patients with 2 or more chronic conditions. In response, CMS launched Medicare CCM in January 2015 as a telephone program to improve the health and care of this vulnerable and targeted patient population who use the vast majority (> 90%) of Medicare funds. This critical primary care component of healthcare transformation has been shown to reduce total costs of care and improve patient outcomes; it is one of the main CMS innovations responding to the Quadruple Aim framework that guides the continuous improvement of healthcare delivery.

Why this payment incentive?

From the outset, Medicare fully planned to have as many eligible beneficiaries as possible enrolled in the CCM in order to significantly improve the health of the high-use population and, therefore, to help maintain Medicare. However, there has been surprisingly slow adoption, low patient recruitment, and an unexpected reluctance to participate in CCM, even though this primary care-focused program improves care management, creates financial opportunity, and prepares participants for opportunities. value-based payments! A 2015 survey found that much of the challenge in advancing CCM is due to the lack of awareness among physicians of the benefits of the program and a general perception that Medicare reimbursements for these services are too low. .

Why a CCM Next Gen program?

When performing an ROI / Gap Analysis, most medical practices find that they do not have the resources and capacity to implement a cost-effective and high-value CCM program. However, one solution to these practices is to outsource CCM services. Unfortunately, some earlier CCM companies viewed the program as a mere financial offer, failing to recognize the importance of CCM to healthcare transformation. To reconcile this disparity, Your Doctor In Touch (YDIT) has developed an innovative new CCM Next Generation (Next Gen) program adhering to Medicare’s vision for CCM.

Scott Rice, MD, PhD, MBA, MS

How is YDIT’s Next Gen CCM advancing the program?

Next-generation CCM strategies that advance Medicare CCM include:

1) Alignment and Coordination of Care: These processes involving all providers and the patient are critical to the successful delivery of the next generation of CCMs and are initiated as soon as possible after patient enrollment.

2) Precision and Personalization: Patient centric and meet patients where they are at by asking them “What matters?” Rather than “What’s wrong?” And leverage shared decision making to involve patients in their care.

3) Global Human Health: Managing and coordinating all aspects of care and filling identified gaps in care ensure holistic medicine.

4) Patient Safety and Risk Management: Vigilant care managers regularly review the determinants of health to assess each patient’s health risks and regularly assess home safety and risk of harm, from medications to falls.

5) Early detection and reporting of patient deterioration: To improve patient outcomes and reduce Medicare waste, ongoing monitoring of patient deterioration is performed and, once detected, an alert is immediately sent to the supervising physician within the goal of bypassing an avoidable emergency or hospital visit.

6) Improve Patient Care Experience: The increase in patient satisfaction resulting from the above strategies will improve CAHPS scores.

7) High-value care: Electronic clinical quality measures (eCQMs) to be submitted for Medicare incentive payments are monitored and managed. The completion of reportable actions is regularly assessed, coordinated and documented in each physician’s EHR by CCM staff. This value-added feature keeps physicians informed of outstanding measurements and is available to all physician offices and healthcare systems participating in Medicare’s Quality Payment Program. For independent firms that are not part of a larger organization, Next Gen CCM will compile and file reports and obtain health insurance rate improvements for them as they would receive, for example, as an ACO member. . Thus, Next-Gen CCM increases physician income through double Medicare payments – direct reimbursement of CCM services plus a positive performance payment adjustment.

In summary, the added benefits of the next generation of CCMs advance the Quadruple Goal, making CCM worth re-evaluating as a service that improves patient satisfaction, preserves Medicare dollars, helps healthcare practices. primary care to increase incomes and, above all, improve the lives of the patients who entrust their care to us on a daily basis.

For more information, contact Richard Grosso at (561) 861-5141 or [email protected].

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