What’s Ahead in 2025: CMS Key Changes for Chronic Care Management Reimbursement and Compliance

Course Description:

CMS adding more codes and adding new concepts like Principal Care Management, fees increment etc. for the effective care management. Chronic Care Management (CCM) has become a hugely profitable endeavor for many healthcare providers. More vendors are coming to the “playground” with their software, clinical teams, and billing capabilities. Providers must be more vigilant in choosing CCM vendors because the billing is always done under providers making them accountable for everything the vendor is doing. Understanding compliance, knowing best practices, and starting off appropriately is essential for a Chronic Care Management program to be effective, compliant, and efficient.

This webinar will outline guideline changes as well as revisions made by the CMS. This session will highlight what is needed to keep providers compliant with billing Chronic Care Management services. We will discuss the new principal management code and how that plays into the care of patients. These codes will be discussed as CMS recognizes chronic care as a critical component of care that contributes to better health and care for those we serve. Expert Dr. Irina Koyfman, DNP, NP-C, RN, will review the latest CMS Medicare’s changes in care management, Federally Qualified Health Centers (FQHCs), preventive care, behavioral health services and telehealth; and also guide you to how to be proactively compliance with these changes. These changes in physician payment policies can impact your practice’s reimbursement and payment systems.

Learning Objectives:

To verbalize key component of CCM
To summarize evaluation plan
To identify what is needed for the Implementation Plan
Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements
Examine the Scope of Services required to bill Medicare for CCM services
Identify how CCM can close care gaps and engage patients
Assess the financial and quality implications of incorporating CCM in your practice
Recognize the importance of CCM in relation to quadruple aim

Areas Covered in the Session:

Sobering Statistics
History of CCM
What is Chronic Care Management
CCM Activities
Patients Eligibility
Examples of Chronic Conditions
Provider Responsibility
- Face-to- Face Visits ( within 12 month)
- Consent
- Establishing, Revising and Providing pt with a Comprehensive Care Plan
- Designated care team member
- Certified EHR
- 24/7 coverage
Initiating Visit
Consent
Comprehensive Care Plan
Billing
Who can bill for CCM?
- Physicians and Non-Physician Practitioners (NPP)
- Certified Nurse Midwives
- Clinical Nurse Specialist
- Nurse Practitioners
- Physician Assistants
- RHC and FQHC
- Hospitals & Critical Access Hospitals
Who can not bill for CCM?
- Clinical psychologists
- Podiatrists
- Dentists
Who can provide CCM
Clinical Staff
- CPT Definition
- CMS Definition
Know the Rules
- Transitional Care Management (CPT 99495 and 99496)
- Home Healthcare Supervision (HCPCS G0181)
- Hospice Care Supervision (HCPCS G0182)
- Certain End-Stage Renal Disease (ESRD) services (CPT 90951- 90970)
Bonus Codes for Specialists
Principal Care Management (PCM)
Reimbursement Opportunities
Benefits of Implementing CCM
Case Manager Case Load
Pros and Cons of Outsourcing CCM
Tips for outsourcing success
CCM Platforms Overview
What to look for in the software
Pros and Cons of Using EMR for CCM
Best Practice
FAQs

Suggested Attendees:

Nurses
Doctors
Nurse Practitioner
Population Health Officers
Innovation officers
CNO/ CMO
Billers
Physicians
PCP (MD, NP, PA)
Specialists (MD, NP, PA)
Nurse Managers
C-Suite Healthcare Executives

About the Presenter:

Dr. Irina Koyfman, DNP, NP-C, RN, is a Nurse Practitioner and a Doctor of Nursing Practice with 25 years of nursing and 15 years of executive experience. Dr. Koyfman is an expert in the Patient-Centered Medical Home (PCMH), Home Health, Healthcare Start-ups, Transitional Care, Community Health, Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Care Coordination. Dr. Koyfman is a dedicated and enthusiastic clinician with an entrepreneurial drive. She has a history of establishing 4 successful healthcare ventures, where she drove significant operational growth (up to1,000%), built successful teams with high retention rates, and improved patient satisfaction and patient outcomes. She is a Subject Matter Expert in CCM and RPM, making her a frequent presenter at multiple conferences. As a founder of Affinity Expert, a healthcare consulting company, she has been consulting primary care providers on all aspects of CCM and its successful clinical, operational, and financial implementation. She has created a growing community of clinicians through her CCM/RPM groups on Facebook and LinkedIn where she provides free information and education to providers. She loves to give back and volunteers on multiple boards along with hands on volunteer work.

Additional Information:

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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