2015 payment final rule addresses chronic care, EHRs
A final rule on 2015 Medicare physician payments addresses chronic care management (CCM) and requirements for the EHRs supporting the services.
Medicare will pay a separate fee to account for the “relative resources” used in furnishing CCM services. Practices are expected to conduct 20 minutes of CCM per patient per month for those with two or more chronic conditions expected to last at least 12 months or until death. The chronic conditions are defined as placing the patient “at significant risk of death, acute exacerbation/decompensation or functional decline,” with a “comprehensive care plan established, implemented, revised or monitored.”
The new code for valuation of CCM services to qualifying patients is GXXX1.
However, CMS heard from many stakeholders that current EHRs are not as interoperable as anticipated by the agency for successful CCM. While CMS said it is necessary to require certified EHRs as a condition for the separate CCM payment to ensure adequate capabilities to enable members of the care team to have timely access to information that informs the care plan, the agency conceded that requiring the most recent edition of certification criteria could impede broad use of the CCM service.
“Accordingly, we are modifying our proposal to specify that the CCM service must be furnished using, at a minimum, the edition(s) of certification criteria that is acceptable for purposes of the EHR Incentive Programs as of December 31st of the calendar year preceding each PFS payment year (hereinafter ‘CCM certified technology’) to meet the final core technology capabilities (structured recording of demographics, problems, medications, medication allergies and the creation of a structured clinical summary),” according to the rule.
Practices can use either the 2011 or 2014 editions of certification criteria for CCM payment in 2015.
“Practitioners must also use this CCM certified technology to fulfill the CCM scope of service requirements whenever the requirements reference a health or medical record,” according to the rule. “This will ensure that requirements for CCM billing under the PFS are consistent throughout each PFS payment year and are automatically updated annually according to the certification criteria required for the EHR Incentive Programs.”
The final rule will be published on Nov. 13.
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.