Why the Need for the General Care Management Program?
The Financial & Human Cost of Chronic Disease in The United States is Staggering. Check Out The Chart Below.
What is General Care Management (GCM) CPT G05011?
Medicare pays separately under the Medicare Physician Fee Schedule for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. The average reimbursement per qualifying patient per month is $42 and can reach up to $142 for complex patients.
General care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions, psychiatric and/ or behavioral health conditions expected to last at least 12 months, or until the death of the patient.
- These conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
- Comprehensive care plan established, implemented, revised, or monitored.
New conditions are being added as CMS has elaborated on the definition of a chronic condition. Examples of chronic, psychiatric and/or behavioral health conditions include:
- Alzheimer’s disease and related dementia
- Chronic Kidney Disease
- Cancer (almost all cancers)
- Chronic Obstructive Pulmonary Disease
- Chronic Pain & Fatigue
- Atrial Fibrillation
- Obesity Stroke
- Arthritis (osteoarthritis and rheumatoid)
- Autism Spectrum Disorders
- Heart Failure
- Ischemic Heart Disease
- Migraine/ Chronic Headache
Physicians and the following non-physician practitioners may bill the new GCM service:
- Certified Nurse Midwives
- Clinical Nurse Specialists
- Nurse Practitioners
- Physician Assistants
Only one practitioner may be paid for the GCM service for a given calendar month.
Note: Eligible practitioners must act within their State licensure, scope of practice and Medicare statutory benefit. The GCM service may be billed most frequently by primary care physicians, although specialty physicians who meet all of the billing requirements may bill the service. The GCM service is not within the scope of practice of limited license physicians and practitioners such as clinical physiologists, podiatrists, or dentists, therefore these practitioners cannot furnish or bill the service. However, CMS expects referral or consultation with such physicians and practitioners by the billing practitioner to coordinate and manage care.
CMS provided an exception under Medicare’s “incident to” rules that permits clinical staff to provide the GCM service incident to the services of the billing physician (or other appropriate practitioner) under the general supervision (rather than direct supervision) of a physician (or other appropriate practitioner).
We provide all the tools and resources needed to Participate in the bill for GCM and allow you to begin receiving the financial benefits quickly while improving the health of your chronically ill Medicare patients. We do all the work, which gives you access to this additional reimbursement without placing burden on your practice or your staff!
What are the Benefits of GCM?
Make up to $300,000 a year gross annual revenue
We schedule all the GCM patients Preventative and Health Maintenance appointments increasing in-office encounter revenue 20%- 30% on average
Improve your quality measures for other incentive programs
Stay focused on in-office patient care and let our staff provide the non-face-to-face burden of your chronically ill Medicare patients
Free up time to either enjoy time outside of the office or potentially see more patients
Satisfied patients are more likely to adhere to their care plans and continue to be treated by providers that are invested in improving their health
If you bill services under Medicare Part B and do not meet the low volume exclusion for 2018 you would be subject to MIPS for an FQHC. RHCs are still subject to MIPS.
Care Management services provide a continuum of care for patients to improve patient outcomes and reduce total cost of care
Providing 24/7 access to care provides patients with the support needed to better manage their chronic conditions and overall quality of life
Continued care management of the patient improves adherence and patient literacy so they can take an active role and proactive approach to managing their overall health including diet, exercise and nutrition
Care management support addresses gaps in care, provides assistance managing chronic conditions and episodic problems that may otherwise go unaddressed, resulting in poor patient outcomes, costly hospitalizations, procedures or additional chronic disease states
Improved patient adherence and compliance starts with education and literacy. By providing essential patient-centric information patients can understand the need for compliance and be better informed to make the correct decisions in self- management
Patients participating in the CCM program have access to 24/7 care support provided by our RN Clinical Care Team
What are the Challenges to Value-based Care?
Research studies have demonstrated time and again that providing care management improves patient outcomes and reduces total cost of care. CMS recognizes these numerous studies conducted over the last decade that demonstrate that Care Management provides patients with chronic conditions with the much needed support and health coaching to improve quality outcomes and reduce total cost of care. However, there are several challenges that have prevented many providers from participating in the General Care Management Program and other value- based care initiatives.
What are Outcomes of Providing GCM Services?
GCM Engagement & Interactions