Time spent on care coordination outside of the face-to-face visit will receive pay recognition in 2015, as a result of a regulation from the Centers for Medicare & Medicaid Services.
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On Oct. 31, CMS officials released the final 2015 Medicare Physician Fee Schedule rule.
On Oct. 31, CMS officials released the final 2015 Medicare Physician Fee Schedule rule, which lays out how much, and under what conditions, payment will be made for providing care coordination services to Medicare patients with multiple chronic conditions.
Starting Jan. 1, about $40 per patient per month can be earned for non-face-to-face chronic care management services, such as developing and revising the care plan, communicating with other treating providers, and managing medications.
The billing codes – CPT codes 99490 and 99487 and 99489 – apply only to Medicare patients with two or more significant, chronic conditions. CMS plans to make a bundled payment for codes 99487 and 99489, according to the rule.
CMS will also allow more “flexibility” in the supervision of clinical staff who provide care coordination services. Under the rule, physicians can bill “incident to” services provided by clinical staff members, even if they are not direct employees and are under general, but not direct, supervision.
CMS said the rules for “incident to” services are somewhat looser than usual because of the nature of non-face-to-face care coordination, which often involves after-hours contact with nurses and coordination with providers who are not direct employees of the physician practice.
The fee schedule final rule also expands access to telehealth services for Medicare beneficiaries. Medicare will now allow annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services to be performed via telemedicine.
CMS is also finalizing changes to the Open Payments Program, which aims to increase transparency by requiring drug, device, and biological manufacturers to report on their payments to physicians and teaching hospitals. CMS published the first round of payment data on Sept. 30, 2014.
The most significant change for physicians is the elimination of the continuing education exclusion. Currently, manufacturers do not have to report payments made indirectly to speakers at continuing medication education (CME) courses, provided the events are organized by certain accredited groups (the Accreditation Council for Continuing Medical Education, the American Academy of Family Physicians, the American Medical Association, or the American Osteopathic Association) and that the manufacturer has not had a role in recruiting or influencing the speakers.
Under the change finalized in the rule, CMS would no longer provide the exemption only for CME events run by accredited groups. Instead, indirect CME payments will be excluded from reporting across the board, provided the payments meet other rules about lack of industry interference. The new rules will take effect Jan. 1, 2016.
The CME change “will create a more consistent reporting requirement, and will also be more consistent for consumers who will ultimately have access to the reported data,” CMS wrote in a fact sheet on the rule.
The agency will also require manufacturers to report stocks, stock options, or any other ownership interest as distinct categories. The changes aren’t expected to be implemented until the 2016 data collection period, according to CMS.
The final fee schedule rule also reminds physicians of the looming Sustainable Growth Rate cut. Unless Congress acts to avert the cut before March 31, 2015, physicians will face on average a 21.2% across-the-board Medicare fee reduction.
The final rule will be published in the Federal Register on Nov. 13.