Centers for Medicare and Medicaid (CMS) in the Federal Register July, 2013 revealed the first non-fee-for service reimbursement model to meet the complex care needs of patients with more than one chronic condition. This new chronic care management model is planned to unfold in October, 2015.
This is the first non-for-fee care model established by the Affordable Care Act to reimburse primary care providers for managing Medicare patients with two or more chronic conditions, even when contacts are made by phone or email rather than face to face.
To qualify for this program, primary care practices need to have electronic health record (EHR) systems with the ability to exchange information on the patient with other providers. The practice must be available to patients 24/7.
To accommodate this, Medicare has loosened its “incident to” rule, which requires doctors to directly supervise nurse practitioners and physician assistants. Practices will be allowed to outsource the coverage or even build it into their on-call arrangements with other providers.
The key will be to clearly document the 20 minutes that are spent communicating with the patient each month and that the practice provides patient access to providers 24 hours every day. This chronic care reimbursement model is an ideal opportunity for providers to demonstrate comprehensive chronic disease management throughout the disease trajectory.