Welcome to TIM Talks: 

Establishing CBO-Physician Collaborations to 

Implement Reimbursable Chronic Care Management 

Services 

March 30 , 2017
Chronic Care Management 

Contracting Steps with 

Physician Practices

Timothy P. McNeill, RN, MPH

Healthcare Consultant
Chronic Care Mgmt. Opportunity

Financial Model

Role and Responsibilities

How to get started 4

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New Business Opportunities Abound

• The shift towards financial incentives that align with 

preventing costs has created new business opportunities

– MACRA

• Merit Incentive Payment System (MIPS)

• Alternative Payment Models (APMS)

• Population Health

– Identification of populations that are most at-risk for 

increasing costs

– Stratification of the highest risk population

– Need for programs and services that can address the 

factors that will lead to increased costs
Chronic Care Management Opportunity

• Chronic Care Management CCM 

– Benefit established in 2015 targeting Medicare

– CPT Code: 99490

• 20 min of clinical staff time

• Complex Chronic Care Management

– Expanded Benefit beginning January 1, 2017

– CPT Code: 99487

• 60 min of clinical staff time

– CPT Code: 99489

• Ea. Additional 30 min of clinical staff time
Eligibility

• Chronic Care Management services can be provided to 

any Medicare FFS beneficiary that meets the following 

criteria:

– Must have Medicare Part B benefits

– Co-Insurance requirements apply

– Must have two or more chronic conditions that are expected to last at 

least 12 months

– Chronic conditions could lead to worse health outcomes or death is not 

properly managed

• Eligibility for CCM and Complex CCM are the same

– Intensity of services defines which code to use
Rate and Duration of Services

CPT Code Rate Duration

99490 - CCM $42.71 Billed each calendar 

month

99487 - Complex

CCM

$93.67 Billed each calendar 

month

*only one CCM 

code can be billed 

per month

99489 – Add on per 

30 min

$47.01 Billed for each 30 

min of additional 

services beyond the 

99487 - 60 min 

encounter
Chronic Care Management Opportunity

• Medicare Providers can deliver this service or contract 

with a third-party care management company to provide 

the service

• Services can be provided by “General Supervision”

– Incident To rules have been changed to include Transitional Care 

Management and Chronic Care Management Services as 

services that can be rendered under General Supervision

• Requires development of a Person-Centered Care 

Management Plan
Target Population

• Concerns have be raised that certain populations will have 

limited access to these services

– Minority Populations

– Rural Populations

– Low-income Populations (Duals)

• Congress mandates that CMS report the utilization of 

these services by high-risk populations
Creating a Care Plan

• Services that can be included as part of the Chronic Care 

Management Person-Centered Plan

– Education and outreach

– Disease Self-Management Support Services

– Care Coordination 

– Communication with all providers

– Support to address Psycho-Social Barriers impacting health

– Medication Reconciliation

– Health Coaching services
Role of the Clinician

• Obtain Beneficiary Consent

• Review and authorization of the Person-Centered Plan

• Provide General Supervision for the services rendered in 

accordance with the Person-Centered Plan

• Submit reimbursement claims based on the totality of 

services rendered during each calendar month
Role of the CBO

• Support the development of a Person-Centered Plan

• Provide services in accordance with the Person-Centered 

Plan

• Provide face-to-face AND/OR non-face-to-face services 

to each identified beneficiary each calendar month

• Document services to include start and stop times

• Submit documentation and time totals to the provider 

each calendar month
Benefits to the Clinician

• Increased compliance with prescribed treatment regimen

• Increased revenue resulting from increased E/M visits and 

preventive health visits

• Additional support for moderate-high risk patients 

without building the chronic care management delivery 

system

• Improved quality measures 

– Alternative Payment Models

– Merit Incentive Payment System (MIPS)
Benefits to the CBO

• Clinical Integration with community providers

• Incorporation of preventive health programs into the 

treatment regimen

• Program sustainability pathway by operating as a contact 

case management organization serving moderate-high 

risk Medicare beneficiaries with 2 or more chronic 

conditions

• Reliable revenue source to support program expansion
Path to Sustainability

• Identify local providers participating in alternative 

payment models

• Identify small to medium size physician practices that 

lack infrastructure to build a chronic care management 

program

• Meet with the practice manager and/or medical director to 

present the model 

• Outline the potential revenue and the benefits to each 

organization along with expected health outcomes 
Process Steps

• Express your interest in providing chronic care 

management services as a contracted CBO partner

• Define the services that your organization would provide

• Provide a sample care management plan that includes the 

services you will provide

• Outline how you will provide the necessary staff to 

implement the program and the frequency

• Define how your services will integrate with the clinical 

services provided by the clinic

• Define the methods that will be employed to increase 

revenue to the practice
Contract Model Anywhere USA AAA

• Provide Person-Centered Planning support services

• Define a person-centered plan that incorporates the 

strength of the organization

• Execute the person-centered plan

– Assess for social determinants of health

– Define a plan to address defined psycho-social barriers

– Provide linkages to community resources

– Enroll participant in relevant evidence-based programs

• CDSMP

• Fall Prevention

• PEARLS, etc.
Evidence-Based Program Model

• Define your evidence-based programs as part of an 

overall Chronic Disease Care Management Program

• Participants will receive health coaching to support them 

with completing all relevant EB programs according to 

the menu of services you provide

• Health Coaching and EB program delivery will occur atleast monthly over a 12 month period

• Develop a business model that incorporates revenue over 

the year per beneficiary in comparison to your costs
Revenue Model - Physician

Code Service Description Rate

G0506 Development of CCM PersonCentered Plan$63.88

G0438 Annual Wellness Visit/PPPS $173.70

99497 Advanced Care Planning $82.90

99213 Level 3 E/M Visit once per quarter for

prevention

$73.93 X 4 = $295.72

99214 Level 4 E/M Visit to address medical 

needs – 2 per Year

$108.74 X 2 = 

$217.44

99489 Add-On Complex CCM for physician 

office staff x 3

$47.01 X 3 = $141.03

Grand 

Total

$974.67 per

person/year
Revenue Model - CBO

Code Service Description Rate

99487 Complex Chronic Care Management $93.67 X 12 = 

$1,124.04

Grand 

Total

$1,124.04 per

person/year
Creating a Win Win for both organizations

• Physician

– Improved patient compliance 

– Dedicated care management staff to provide additional support 

to patient population

– Access to community resources

– Access to Medicaid-funded LTSS provider resources and staff 

that are experts in serving older adults and persons with 

disabilities

• CBO

– Clinical Integration

– Sustainable Revenue

– Partnership that supports MCO contracting
How to Get Started

• Identify a target population to start with

• Identify a physician in the practice that will pilot the 

intervention

• Start with populations that we may be mutually serving

– Duals

– HUD Funded Senior Housing

– Assisted Living Populations

– Waiver participants

– Senior Center participants
Scope of Work

• Establish a well defined scope of work

• Outline roles and responsibilities of each party

• Determine a start date

• Obtain commitment from management, physicians, and 

support staff
Questions