Chronic Care Management: All You Need to Know About the 20-Minute Requirement

You may have heard of CCM (chronic care management) but are uncertain about what the 20-minute requirement involves.

In this article, you will learn more about chronic care management in 2022, what a chronic care management program requires, and everything you need to know about the 20-minute requirement.

While implementing a CCM program takes time, money, and staffing, you will find this is the most up-to-date guide on the 20-minute requirement.

What Is Chronic Care Management?

Chronic care management is a service focusing on individuals on Medicare with at least two or more chronic conditions such as diabetes or arthritis. Various clinics use CCM to provide preventive medical care to eligible patients, helping them take a proactive approach to their health.

Additionally, it helps them stay connected to their provider, allowing patients to eliminate their chronic diseases through preventive measures.

With a good chronic care management program, you can help your clinic by providing early interventions for patients. Doing so encourages compliance through supportive lifestyle improvements, reducing hospitalizations and complications, and medication regimens.

Conditions That Qualify for Chronic Care Management Programs

A chronic care management program can assist patients with chronic conditions that you expect to last for one year or longer. Patients who qualify for the program must consent before entering one. However, a CCM patient must have a care plan.

Every encounter must last for at least 20 minutes and may go up to 60 minutes each month. Those who are eligible for the program must have a condition that qualifies. You’re likely familiar with most of these, so here is a list including some of the common conditions:

• Alzheimer’s disease

• Arthritis

• Asthma

• Autism

• Blindness

• Cancer

• Cardiovascular disease

• Deafness

• Diabetes

• Endometriosis

• Epilepsy

• Fibromyalgia

• High blood pressure

• HIV/AIDS

• Migraines

• Obesity

• Psoriasis

• Sickle cell anaemia

• Sleep apnea

• Thyroid disease

• Tuberculosis

The 20-Minute Requirement

Now that you are familiar with what the CCM program entails, let’s go into further detail about the 20-minute requirement.

1. How Do You Calculate Staff Time?

The CCM services code requires at least 20 minutes of clinical time by a qualified staff member. This code differs from the standard coding procedure in Current Procedural Technology, allowing a service report upon the mid-point of time reached.

However, you can’t report a CCM if you document the service for under 20 minutes each month.

Currently, the specific requirements for how you must document the 20 minutes are not established. Yet, it’s in the best interests of your clinic to confirm the start and stop time, a service review, and a date.

2. What Are the Billing Codes for the 20-Minute Requirement and CCM?

The chronic care management coding has five CPT codes you can use to report CCM services. The following CPT codes and their requirements are as follows:

• CPT code 99490: A non-complex CCM that requires the 20-minute timed service that the clinical staff provides.

• CPT code 99439: For every additional 20 minutes of staff time providing non-complex CCM directed by a qualified healthcare professional.

• CPT code 99487: A complex CCM providing a 60-minute service by clinical staff to revise or build a comprehensive care plan involving moderate to high complexity in a medical decision.

• CPT code 99489: For every additional 30 minutes of service providing complex CCM directed by a qualified healthcare professional.

• CPT code 99491: A 30-minute CCM service provided by a qualified healthcare professional.

3. Who Qualifies in Providing the 20-Minute Requirement and CCM?

A clinical staff member who calculates the time to meet the elements of the chronic care management codes must qualify as a licensed clinician under a physician’s supervision.

These don’t include receptionists, schedulers, and coordinators unless they have a license. However, it does include:

• Residents

• Nurses

• Nurse practitioners

• Physicians or physician assistants

• Licensed medical aide

4. How to Schedule Staff to Provide the 20-Minute Requirement and CCM

Scheduling qualified staff to provide CCM services will depend on the number of patients your practice has elected. To plan the team schedule accordingly, your clinic should determine the number of eligible patients for the chronic care management program.

Next, your clinic should determine the number of patients you will realistically elect for CCM.

If you have a smaller practice, you may choose to assign an existing staff member to coordinate chronic care management. A larger clinic can hire a full-time staff member – such as a registered nurse care coordinator – to manage CCM alongside other services.

You may also choose to subcontract CCM services to case management companies. However, the case manager must meet requirements that you should integrate with the care team.

An Overview of the Other Chronic Care Management Requirements

You know enrolled patients need at least 20 minutes of documented service for the billing code requirements. However, here is a quick overview of the other conditions in a chronic care management program.

For non-complex chronic care management:

• At least two chronic conditions you expect to last for 12 months or longer.

• Verbal or written patient consent.

• The personal care plan is recorded in an electronic healthcare system with a copy provided to the patient.

• Members must have 24/7 patient access for urgent care.

• Non-face-to-face communication between patients and the care team.

• 20 minutes of staff time each month spent on non-face-to-face CCM services directed by a qualified healthcare professional.

• A qualified healthcare professional who provides CCM services must report it using CPT code 99491, requiring 30 minutes of personal time spent in care.

Complex CCM includes the following requirements:

• Shares the same service elements with the non-complex CCM requirements listed above.

• At least 60 minutes of clinical staff time.

• Moderate to the high complexity of medical decisions.

How Do You Document CCM in an Electronic Health Record?

The documentation of time and services provided are crucial for billing. The CMS (Centers for Medicare and Medicaid Services) requires the standard recording of the patient’s health information – a certified EHR (electronic health record) meets the requirement.

The EHR should have the following documentation:

• Patient consent.

• A comprehensive care plan containing a list of problems, measurable treatments, planned interventions, medications, and interactions with outside resources and providers.

• 20 minutes of non-face-to-face staff time every month.

Some clinics already have CCM documentation assembled in the EHR’s outpatient records. Meanwhile, other clinics have specialized software for tracking time and ensuring all requirements meet chronic care management billing.

In addition to tracking documentation, some software can send reminders to providers, patients, and caregivers. However, some practices choose to track CCM manually.

The Advantages and Disadvantages of Chronic Care Management Software and Third-Party Companies

You have three options if you consider using CCM software to document activities.

1. Your Clinic’s EHR

Since your clinic may have a CCM portal within the EHR, the advantage is that you have convenience on hand. Since you work with an EHR, you can access the CCM portal in secure software.

However, the downfalls of this are the costs and limitations. Most EHR platforms have an additional charge for using the CCM function. Additionally, most CCM portals built into an EHR have limiting capabilities and don’t offer providers or patients enough relevant information.

2. Third-Party CCM Software

If your clinic purchases third-party CCM software, you may find it is more robust and functional because it is a more mature product.

However, third-party software is more costly and can be inconvenient. That’s because its system requires additional logins and clinical training. In turn, this can decrease company time, and the staff may be hesitant to use it.

3. An Outsourced Chronic Care Management Company

When subcontracting a trusted CCM company to work within your EHR, the one advantage to this is that there’s no need for logins to other systems. They will upload patient assessments to your EHR in real-time, providing more convenience.

Additionally, you receive higher-quality data, offering customized clinical pathways for dynamic patient conditions. A CCM company also doesn’t charge software fees, saving you money while receiving a robust platform.

However, you must invest in a CCM company you can trust for your patients. Therefore, researching a company aligning with your clinic’s internal values is crucial. That way, you enhance your relationships between the provider and patient.

What Are the Benefits of Chronic Care Management in 2022?

Healthcare facilities already have an overload of work to accomplish. Therefore, it may be difficult to imagine implementing even more work with chronic care management. The good news is that CCM services aren’t challenging to provide for patients.

A chronic care management program is excellent in providing valuable insights into patients. Plus, chronic care management in 2022 has a more streamlined approach.

When implementing a CCM program correctly, you can help providers:

• Improve responsiveness via frequent patient contact, enabling your team to identify new changes in the patient’s health. Plus, it helps pinpoint high-risk patients.

• Anticipate conditions that often require acute care.

• Connect with patients through monthly conversations to better understand the patient’s healthcare challenges.

• Prevent acute care by collecting more details from patients. Providers can discover health deficiencies during monthly calls and allow patients to express concerns about their care.

• Increase revenue from CMS reimbursements, leading to higher budgets for additional resources or improving patient care.

Implementing Chronic Care Management in 2022

Now that you have everything you need to know about the 20-minute requirement in CCM, it is time to plan and implement a chronic care management program.

Whether you outsource your CCM program or do this yourself, a good CCM program will benefit your patients.