CPT 99490: How Our Small Family Practice Is Using Technology To Become More Patient-Centric

By Michael Paul Gimness, MD, owner of Family Medical Specialists of Florida

Statistics show the average Medicare beneficiary with two or more chronic conditions sees between five and seven different healthcare providers on a consistent basis. Like many small practices, ours has faced many challenges in caring for these patients. Indeed, many essential but mundane administrative tasks associated with these patients have historically consumed a large measure of our staff’s time and resources.

But thanks to a new CPT code introduced by the Centers for Medicare and Medicaid Services (CMS) and innovative technology and services, we are delivering more effective and more patient-centric care to our Medicare population than ever before.

First, Let’s Talk About The Code
You’re likely familiar with Medicare’s CPT code 99490, which took effect in January 2015 and seeks to boost patient care efficiency and quality by encouraging practices to develop chronic-care management (CCM) programs for Medicare patients. The code reimburses physicians for previously unpaid services like medication reconciliation and document collection from other physicians treating Medicare patients. In return for coordinating the care provided by all these physicians through a CCM program, each “lead physician” can receive an average of $41 per patient, per month, in added revenue.

Like many other smaller practices, ours initially feared that we would not be able to summon the resources needed to develop and implement a CCM program. However we uncovered a cost-effective approach that not only provides us with increased revenues, but also helps us to develop the CCM program that enables us to deliver more effective, patient-centric care to our Medicare patients with multiple chronic conditions.

Now Let’s Talk About The Technology
The solution we discovered, and ultimately came to implement, was developed by CareSync to handle many of the essential but time-consuming tasks needed to comply with CPT code 99490, such as medical reconciliation and medical records collection. These can easily tax smaller practices with limited staff members and fewer resources.

The web-based technology- and services-enabled approach independently collects data uploaded regularly from each patient’s providers without impacting the staff’s day-to-day routine. The solution’s value in this regard has helped us to sell the benefits of CPT code 99490 to clinical and administrative staff. Previously, if I needed a GI colonoscopy report, for example, I’d have to call for it myself or ask my staff to track it down. Today, I can simply access and download the report from the web portal to my files and my printer.

Improving CCM Adoption
The technology and services also make it easier to convey the benefits of CCM to patients. In addition to explaining their eligibility for CCM, we explain to patients how the technology helps us to better manage their care by making 24/7 access to registered nurses available to address their concerns and questions, as well as by making secure, 24/7 access to their charts and records available to all their physicians and designated caregivers.

The solution can also be customized to deliver all or selected updates to patients, their physicians and caregivers. One of my patients in particular loves the beep he gets from his phone whenever an update is made to his records, for example. He’s always coming in and asking me if I’ve looked at the portal to see his latest visit for chemotherapy or another specialist visit. The flexible nature of the technology and services greatly impacts patient buy-in and engagement, and enables a personalized experience for each of my enrolled patients.

Positive Financial, Staff, And Patient Impacts
From a financial perspective, we’ve found an easy, value-added way to help take better care of our Medicare patients with chronic conditions, at virtually no cost to our practice. The CMS reimbursement pays for the technology and services, and we also realize a residual payment on each patient we qualify for CCM each month. As a result, we’re bringing in an estimated $20,000 to $25,000 a year in extra revenue for services that previously went unreimbursed. With that money, we’re then able to pay for additional resources and staff to help us achieve our primary goal of delivering more effective and more patient-centric care.

Indeed, our entire practice and CCM patient population are enjoying very positive impacts. As records requests and med reconciliations have largely been off-loaded to an “assistant” that works in the background, my staff and I can spend more time where it really counts: taking care of our patients.