Why are doctors skipping chronic care reimbursement?

From the mHealthNews archive
By Eric Wicklund

When the Centers for Medicare & Medicaid Services unveiled CPT code 99490 this past year, it was hailed as a first step in reimbursing providers for the use of telemedicine in chronic care management.

But are they taking advantage of this code?

"I think most physicians are missing it," said Michelle McKamy, a licensed clinician and director of special projects for SmartCCM. "They're finding it difficult to apply."

Based in Dallas, SmartCCM offers turnkey management services for healthcare providers seeking help with patient care management outside the office. They're one of roughly a half-dozen companies in the market, and poised to help providers who don't have the time or resources to connect all the dots.

[See also: CMS boosts telehealth in 2015 physician pay schedule]

But McKamy says not enough providers are even paying attention to 99490. She notes Aetna now covers the code – but as of yet, no providers have come to the insurer looking for reimbursement.

According to a primer put out by SmartCCM, "CPT 99490 reimbursement specifically incentivizes physicians to better manage patients with multiple chronic conditions, the 32 percent of our population that accounts for an overwhelming share of healthcare services such as prescriptions fills, home healthcare visits, office visits and the vast majority of general healthcare and Medicare spending as well."

"The 99490 Medicare guidelines cover 20 minutes of non-face-to-face chronic care management services per calendar month including establishing, implementing, revising and monitoring patients' care plans for patients with two or more chronic conditions," the primer continues. "The chronic conditions must be one of the CMS's observed 27 chronic conditions, must be expected to last for at least a year or until the death of the patient if that projected date is less than 12 months and, without proper management, the conditions must significantly jeopardize the patient's health, putting them at risk of functional decline, exacerbated health risks, or death."

According to McKamy, that's all well and good, but what doctor has the time or energy to chart every minute of every phone call made or text message or e-mail sent to check up on a patient meeting those standards?

All those minutes add up. McKamy echoes national estimates that have placed the amount of lost reimbursed income for a doctor who doesn't use CPT code 99490 at between $10,000 and $35,000 a year.

Reimbursing clinicians for providing chronic care management services isn't new. The American Medical Association, which devised the Current Procedure Terminology (CPT) code sequence, has long been supporting physicians with Codes 99381-99429, which cover certain visits, exams and counseling services, and Codes 99201-99215, which covers problem-oriented visits and management services. But all of those codes focus on face-to-face visits, whereas 99490 brings telehealth into the equation.