Complex Chronic Care Management and Documentation Requirements

Format: On-Demand Webinar

Presenter: Betsy Rios, CPC 

Duration: 60 minutes

Course Description:

In this webinar we will cover how to navigate the complex requirements of Chronic Management. This webinar will be helpful to anyone providing chronic care management services or those wishing to learn more about possibly providing chronic care management services.  We will discuss the chronic care management program as well as documentation requirements. Attendees will learn how to recognize patients that qualify for this service and the types of encounters that lead to chronic care management and determine what constitutes a chronic condition. We will discuss required components of chronic care management, applicable timelines, what records physicians and coders need to review prior to submission of claims.

Attendees will understand application of Chronic Care Management codes and learn the differences of clinical staff time versus physicians and other qualified healthcare professionals. The webinar will also describe how to determine if you should select chronic care management or complex chronic care management billing codes and how to determine all requirements are met. We will also tell webinar attendees which codes can be reported with chronic care management and which codes cannot be utilized during a CCM period.  

We will also go over multiple clinical scenarios to ensure comprehension of the materials covered. Presenters will show you how to apply these in a clinical setting and how to track these items in the patient chart as well as billing nuances to be aware of. 

 Learning Objectives:

• Recognize qualifying Chronic Care Management encounters
• Identify CCM billable services
• Identify Documentation Requirements
• Understand how to determine Chronic Care Management vs Complex CCM
• Demonstrate understanding of clinical scenarios
• Demonstrate understanding of clinical scenarios

Areas Covered in the Session:

• Chronic Care Management Services
  • CCM overviews and history
  • Who can furnish CCM Services?
  • Supervision Requirements
  • Determining patient eligibility for Chronic Care Management
  • These services are typically Non face-to-face
  • Chronic Care Management Services can assist in reducing geographic and racial or ethnic healthcare disparities.
  • Examples of chronic conditions
• Key Components
  • Patient Consent
  • Required Recorded Patient Health Information
  • EHR Technology Utilization
  • Comprehensive Care Plan
  • Care plan requirements
  • Access to care & Care Continuity
  • 24/7 access to Physicians or other qualified Practitioners or Clinical Staff
  • Continuity of care with a designated practitioner
  • Opportunities/methods for patients and caregivers to communicate with their provider about care
  • Create and exchange or share care documents
  • Manage Care Transitions
  • Access to Care
• Concurrent Billing
• CCM Code Descriptions
  • CPT Code Descriptions for CCM
  • 99437
  • 99489
  • 99490
  • 99491
  • 99439
  • 99487
  • Other Services
  • G0506
• Principal Care Management Codes
  • 99424
  • 99425 (Cannot be billed without 99424)
  • 99427
  • 99437
  • 99439 (Cannot bill without 99437)
• Live Q&A session

Suggested Attendees:

• Healthcare Executive CEOs, CFOs & COOs
• Doctors
• Nurse Managers
• Nurses and Nurse Practitioners
• Billers
• Coders or Coding Management
• Healthcare Providers
• Care Coordinators
• Physician Practice Managers
• HIM Directors and Staff
• Population Health Officers
• Innovation officers
• PCP (MD, NP, PA)
• C-Suite Healthcare Executives       

About the Presenter:

Betsy Rios is a seasoned professional who has over 25 years of experience in coding and RCM, Healthcare Receivables management.  She has managed coding and RCM at freestanding clinics, hospital-based clinics, Rural Health Clinics, group clinics as well as Critical Access and PPO Hospitals.  Betsy started in Home Health as a biller and worked her way up to Director of Reimbursement at a home health chain with offices across the country.  She then transitioned into hospital and professional billing and coding, managing these functions for facilities and clinics.  Betsy went to work at a national coding company as a professional auditor and was promoted to Pro Fee Coding Manager, then became the Revenue Cycle Operations Manager. Betsy now focuses on consulting and assisting smaller facilities and clinics with coding and revenue cycle issues.  She is very active in the rural health community and says that solving inefficiencies is her passion.