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CMS Doubles Down on Care Management Programs in the 2020 Physician Fee Schedule

CMS published its Final Rule on the 2020 Physician Fee Schedule on November 15, 2019. The massive 2,000+ page document was packed full of changes, but some of the more notable changes came in the sections addressing payments for care management services, such as Chronic Care Management (CCM), Remote Physiologic Monitoring (RPM) and Transitional Care Management (TCM). CMS also included a new type of care management service called Principle Care Management (PCM).

ChartSpan’s team of CCM and MIPS experts has taken a deep-dive into the Final Rule in the format of an on-demand webinar. Before you watch, here’s a sneak peek of some changes in the Final Rule:

    • CMS added a new G code for an additional 20 minutes of non-complex CCM services, demonstrating that they recognize the challenges providers face when caring for chronically ill beneficiaries.
    • RPM has been added to the list of designated care management services that can be provided under general supervision, including a new CPT code (99458) that covers additional time spent for RPM.
    • TCM has been removed as a concurrent billing exclusion for complex and non-complex CCM. 

A New Opportunity: PCM – Codes G2064 and G2065

These new PCM service codes (G2064 and G2065) are designed for specialists who treat patients with a specific disease that can easily exacerbate. They are to be used by providers until the disease is better controlled. The program requirements closely follow the CCM requirements but do not require the patient to have two or more chronic conditions. With PCM, providers can bill for the time and resources required to proactively support patients who require more assistance to avoid further complications and costs.

MIPS is on the Move

>Although CMS indicated it may shift the category weights of the MIPS composite scores in its Proposed Rule issued in July 2019, it decided to keep category weights the same for the time being. CMS had proposed to increase the Cost category to 20% of the composite score and reduce Quality to 40%. But in the Final Rule, CMS chose to keep the existing category weights the same.

CMS also revealed its intentions to create a new infrastructure with the intent of better aligning MIPS with Population Health and Value-Based Care through the creation of MIPS Value Pathways over the next two years.

Making the Most of These Changes

Designing and administering care management programs in your practice can be challenging. In fact, in a recent Porter Research survey of more than 100 practice managers and physicians, the top three challenges providers with a CCM program face are:

  1. Enrolling enough patients to make the program financially viable
  2. Hiring and maintaining a knowledgeable staff
  3. Ensuring CCM billing is done properly

At ChartSpan, we support the care management needs of hundreds of providers representing tens of thousands of patients every day. We understand the operational and clinical complexities of these programs that often eat away at practice margins.

That’s why we’ve invested millions of dollars into equipping our team of clinical experts with the most advanced technology and training to make sure that each patient receives the care services they need while each physician practice receives the optimal reimbursements they deserve. As an added revenue boost, we offer each one of our CCM customers free access to our MIPS consulting team to ensure quality scores are optimized. The result? The majority of ChartSpan customers received a perfect score (100) on their MIPS scores in 2018.

With the new 2020 Physician Fee Schedule, CMS is making it clear it intends to expand support for care management services, but it is also making sure physician practices follow the rules by adding complexities across the care management services spectrum. Don’t try to do it alone. Turn to the experts at ChartSpan to help you with your care management programs in the new year.

Be sure to check out our on-demand webinar by clicking here.

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