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Care Management / Complex Case Management Billing

  • 1.  Care Management / Complex Case Management Billing

    Posted 10-18-2024 12:42

    Hello!

    Is anyone's organization currently dropping codes for Care Management or Complex Care Management? We are looking to set this up within our RN Ambulatory Care Management team and would love to meet with anyone doing this to learn more about the process. 

    Thanks in advance!

    Jessica Polk (jessica.polk@wellstar.org)



    ------------------------------
    Jessica Polk DrPH MPH BSN RN
    Sandy Springs GA
    (205) 446-8888
    ------------------------------


  • 2.  RE: Care Management / Complex Case Management Billing

    Posted 10-21-2024 12:10
    Hi Jessica

    We have been billing for CCM for many years. We use the following CPT codes: 99487, 99489, 99490, 99439.
    We track
    ● Phone calls and email communication with patient in relationship to the chronic conditions you are
    billing for.
    ● Time spent coordinating care (by phone or other electronic communication) with other clinicians,
    facilities, community resources, and caregivers.
    ● Time spent on prescription management and medication reconciliation.
    ● Add the diagnosis reviewed and add in the assessment the plan going forward.


    Let me know if you have any questions
    Sharon
    Sharon Watts, MN, RN
    RN Supervisor, Ambulatory Virtual Teams
    Virginia Mason Franciscan HealthTM 
    Seattle, WA 

    "The most impactful leaders are those who listen with intention and act with compassion" 

    Caution: This email is both proprietary and confidential, and not intended for transmission to (or receipt by) any unauthorized person(s). If you believe that you have received this email in error, do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.





  • 3.  RE: Care Management / Complex Case Management Billing

    Posted 10-22-2024 09:11
    Hi, Sharon,
    Is this the sole funding for your department?
    Thanks,
    Diane

    Diane E. Herzog MSN, MBA, RN, CCM, CNML

    Cincinnati Children's Hospital






  • 4.  RE: Care Management / Complex Case Management Billing

    Posted 10-22-2024 10:51

    Hi Sharon, 

    Thank you so much for this information. I would love to schedule some time with you to talk through how this is set up in your EHR and other things you have learned over the years. I am going to reach out via your email in your signature to coordinate some time if that works for you.

    Thanks again!

    Jessica Polk 



    ------------------------------
    Jessica Polk DrPH MPH BSN RN
    Sandy Springs GA
    (205) 446-8888
    ------------------------------



  • 5.  RE: Care Management / Complex Case Management Billing

    Posted 10-23-2024 10:19

    Hello,

     

    We bill care coordination codes: G9001, G9002, G9007, 98966, 98967, 98968. If you are planning to bill these codes I am happy to answer any questions I can. Thanks!

     

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan


    Bronson Healthcare – A Forbes Best-In-State Employer (2022-2024)

     




    This message may contain confidential information protected by law through attorney-client privilege or professional peer review/quality evaluation privilege. It is intended only for the individual or entity named above. It is prohibited for anyone else to disclose copy, distribute, or use the contents of this message. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. You may also contact the Bronson Healthcare Group Privacy Officer at privacyofficer@bronsonhg.org





  • 6.  RE: Care Management / Complex Case Management Billing

    Posted 10-28-2024 10:00
    Hi Ashely!

    I would love to set up a time to learn more. Could you give me your email or email me some dates and times to discuss? Jessica.polk@wellstar.org

    Thanks!




  • 7.  RE: Care Management / Complex Case Management Billing

    Posted 10-29-2024 12:18

    Dear Ashely,

    I too would love to have you share any information especially around evidence based chronic care models that you are using for care management. We are setting up our population health team using RN's for hospital follow up and would love some guidance in regards to this. Thank you so much



    ------------------------------
    Toni Kempner RN, MSN, ACRN
    Director of Nursing
    Multnomah County HD, ICS
    Portland, OR
    503-969-6989
    ------------------------------



  • 8.  RE: Care Management / Complex Case Management Billing

    Posted 10-30-2024 07:45
    I am interested as well, my organization does not currently drop these codes, my understanding is the patients had to consent and are billed a monthly fee if we drop certain CCM codes. Any info on this and the care models you use for different disease states would be helpful for me! I am trying to implement a CCM model over the next year with a dedicated FTE just for this.
    Sent from my iPhone

    This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, or an employee or agent responsible for delivering the message to the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message, including any attachments.




  • 9.  RE: Care Management / Complex Case Management Billing

    Posted 11-05-2024 17:21
    Anyone referring to CCM uses the auto text below:

    CCM Referral:
    [x] This patient would benefit from Complex Care Management (Medicare benefit for patients with >2 chronic conditions expected to last >12 months or until death).
    [x] Message sent to Complex Care Mgmt Team box to initiate the referral to program

    Informed consent: The CCM team will discuss the program further and ensure the patient / caregiver consents to the offered services. While not required, please indicate any of the following that have been shared or discussed with the patient:
        [_]  Patient was informed about CCM services
        [_]  Patient was informed about services/potential cost for services and verbalized understanding. Patient understands that Care Management is an opt-out program with the right to participate or decline. Patient provides verbal informed consent.
        [_]  CCM FAQs given to patient 
        [_] In addition to the work required for the visit today, I personally performed an extensive assessment and care planning for the patient's chronic medical conditions. These are documented in the assessment and plan above.The provider can use an additional one time billing code (G0506) at the time of referral


    Once our care coordinator receives the referral he calls to talk with the patient about the program and schedules their intake visit with one of our CCM RN's. Our care managers are assigned geographically as they cover 10 primary care clinics. Once the patient has joined the program the CCM can bill accordingly and they do this on the last working day of the month. The nurses use a standard template for their documentation to ensure they are fulfilling CMS guidelines.

    CMS has very good guidelines on this.

    Let me know if you have any other questions.
    Sharon
    Sharon Watts, MN, RN
    RN Supervisor, Ambulatory Virtual Teams
    Virginia Mason Franciscan HealthTM 
    Seattle, WA 

    "The most impactful leaders are those who listen with intention and act with compassion" 

    Caution: This email is both proprietary and confidential, and not intended for transmission to (or receipt by) any unauthorized person(s). If you believe that you have received this email in error, do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.





  • 10.  RE: Care Management / Complex Case Management Billing

    Posted 10-30-2024 08:24

    Ashley - I too would be interested in learning more about the model/documentation being used for your program. Also wondering if you have an average length of time patients are enrolled in your program?

    Thank you!



    ------------------------------
    Emily Newbury
    Gundersen Health System
    Tomah WI
    ------------------------------



  • 11.  RE: Care Management / Complex Case Management Billing

    Posted 11-11-2024 13:59

    If you expressed interest, can you send me your email and I will coordinate time for a call?

     

    Thank you!

     

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan


    Bronson Healthcare – A Forbes Best-In-State Employer (2022-2024)

     




    This message may contain confidential information protected by law through attorney-client privilege or professional peer review/quality evaluation privilege. It is intended only for the individual or entity named above. It is prohibited for anyone else to disclose copy, distribute, or use the contents of this message. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. You may also contact the Bronson Healthcare Group Privacy Officer at privacyofficer@bronsonhg.org





  • 12.  RE: Care Management / Complex Case Management Billing

    Posted 10-29-2024 12:16

    Dear Sharon, 

    Are you using specific evidence based chronic care protocols for your clients (CHF, DM, CK, CD, COPD)? Any help would be wonderful. And thank you for the above information.



    ------------------------------
    Toni Kempner RN, MSN, ACRN
    Director of Nursing
    Multnomah County HD, ICS
    Portland, OR
    503-969-6989
    ------------------------------



  • 13.  RE: Care Management / Complex Case Management Billing

    Posted 10-30-2024 12:17
    Hi Toni
    This is our criteria:
    • Have two or more chronic conditions (it doesn't matter what they are as we are not doing disease management)

    • Have a PCP in our system who they have seen in the last 12 months for an AWV, TCM, or complex E/M visit (review of 3+ Chronic Conditions)

    • Refer by sending a message to our Cerner poolbox Complex Care Mgmt Team describing what patient is being referred for and we will contact them directly


    Let me know if you have any other questions.
    Thanks
    Sharon
    Sharon Watts, MN, RN
    RN Supervisor, Ambulatory Virtual Teams
    Virginia Mason Franciscan HealthTM 
    Seattle, WA 

    "The most impactful leaders are those who listen with intention and act with compassion" 

    Caution: This email is both proprietary and confidential, and not intended for transmission to (or receipt by) any unauthorized person(s). If you believe that you have received this email in error, do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.





  • 14.  RE: Care Management / Complex Case Management Billing

    Posted 11-04-2024 06:51

    I am also interested in this.

     

    Maybe a SIG for care management would be helpful, not sure how we get this started but would be happy to be involved.

     

     

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan


    Bronson Healthcare – A Forbes Best-In-State Employer (2022-2024)

     




    This message may contain confidential information protected by law through attorney-client privilege or professional peer review/quality evaluation privilege. It is intended only for the individual or entity named above. It is prohibited for anyone else to disclose copy, distribute, or use the contents of this message. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. You may also contact the Bronson Healthcare Group Privacy Officer at privacyofficer@bronsonhg.org





  • 15.  RE: Care Management / Complex Case Management Billing

    Posted 11-05-2024 08:54

    Sharon,

     

    For the medication management, can you share more on how your team is tracking this and the code you are utilizing? We do a lot of patient assistance applications which can be timely. Thanks!

     

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan


    Bronson Healthcare – A Forbes Best-In-State Employer (2022-2024)

     




    This message may contain confidential information protected by law through attorney-client privilege or professional peer review/quality evaluation privilege. It is intended only for the individual or entity named above. It is prohibited for anyone else to disclose copy, distribute, or use the contents of this message. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. You may also contact the Bronson Healthcare Group Privacy Officer at privacyofficer@bronsonhg.org





  • 16.  RE: Care Management / Complex Case Management Billing

    Posted 10-30-2024 15:16

    Hi Jessica,

    I work as a RN care coordinator with in a FQHC. We bill for care management once monthly once we have spent at least 20 minutes managing the patients care. We use code G0511. 

    It would be great to hear of any additional ways people are able to bill for these services, because we also do all the transition of care calls, but have been advised RNs can not bill for this.

    I do hope you find some good information hopefully that we can all share.



    ------------------------------
    Jennifer Pease RN
    NOTCH
    Saint Albans VT
    ------------------------------



  • 17.  RE: Care Management / Complex Case Management Billing

    Posted 11-05-2024 19:04
    Edited by Jennifer Edwards 11-05-2024 19:06

    We have been billing for TCM codes in our Primary Care Transitional Care Clinic through the work our RN Navigator and Physicians provide. I am also leading work for my organization to leverage CMS's PIN and CHI codes for our RN Patient Navigators in Oncology and Chronic/Complex Care. We are working through all of the details and ironing out how to standardize and operationalize using Cerner. It is super exciting! 

    Jennifer Edwards (Mindala), BSN, RN, OCN, LSSGB

    RN Clinical Services Director

    Clinical Services | Navigators

    Banner University Medical Group-Phoenix at Banner University Medical Center Phoenix

    Jennifer.Edwards9@bannerhealth.com
    ------------------------------



  • 18.  RE: Care Management / Complex Case Management Billing

    Posted 11-05-2024 20:55

    Hi Jennifer,

     

    Can you share more on the specific codes you are billing for this: CMS's PIN and CHI codes for our RN Patient Navigators in Oncology and Chronic/Complex Care?

     

    Any other insights are welcomed! Thank you!

     

    Ashley Rosa, MSN, BSN, RN

    Manager Ambulatory Care Management

    Bronson Healthcare Group, Michigan


    Bronson Healthcare – A Forbes Best-In-State Employer (2022-2024)

     




    This message may contain confidential information protected by law through attorney-client privilege or professional peer review/quality evaluation privilege. It is intended only for the individual or entity named above. It is prohibited for anyone else to disclose copy, distribute, or use the contents of this message. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. You may also contact the Bronson Healthcare Group Privacy Officer at privacyofficer@bronsonhg.org





  • 19.  RE: Care Management / Complex Case Management Billing

    Posted 11-06-2024 07:41

    Hi Sharon – Would you be willing to share your documentation template your staff are using?

     

    Thanks for considering –

    Emily.Newbury@gundersenhealth.org