Per CMS, patients must have at least 2 chronic conditions to qualify for CCM. In order for the MyCare Program to stay GI-focused, our patients must have:

• At Least 1 GI-Specific Condition from the list below + Another Chronic Condition (2nd qualifying condition can be any other chronic condition, although most of the patients we encounter have a 2nd GI-related condition):
  
  • Fatty Liver/NAFLD
  • Obesity
  • Irritable Bowel Syndrome (IBS)
  • Inflammatory Bowel Disease (IBD)
  • Ulcerative Colitis
  • Crohn’s Disease
  • GERD

OR

• At Least 3 Underlying Fatty Liver Risk Factor Conditions from the list below (putting the patient at high risk for development or progression of Fatty Liver, whether they have been officially diagnosed yet or not):
  
  • Hypertension
  • Hyperglycemia
  • Hypertriglyceridemia
  • Hyperlipidemia
  • Diabetes
  • Overweight
    
    

Care Coordination Note: For patients who qualify for the MyCare Program with 3+ underlying conditions, we will route those patients to the appropriate provider as needed for continued management of those non-GI conditions.

Give your Medicare and Medicare Advantage patients a flyer (provided to your office by MetaPhy) and let them know that if they qualify, a MyCare Coordinator will be calling to tell them more about the program – it’s that simple!

MyCare Coordinators are set up as users in your EMR, so you may send us direct patient referrals via EMR task/message. Our MyCare Coordinators will be reaching out to all of your qualifying Medicare patients via a letter and follow-up phone call letting them know about the program, but sending them a message via the EMR will result in a much more timely outreach.

Monthly care plans (PDF documents) for each of your active CCM patients will be uploaded to the patients’ charts for your review on a monthly basis.

There is no documented signature required by Medicare for CCM services; however, if these services are being billed under your general supervision, the initial care plan must be signed by the provider, as well as when any significant changes are made to the care plan. We recommend signing care plans each month as best practice.

Just let us know! The MyCare Program is being done under your general supervision, so we will follow any direction that you provide to us.

Just let us know! The MyCare Program is being done under your general supervision, so we can easily unenroll patients if you do not think they should be in the program for whatever reason.

There is no Medicare requirement for patients to “re-qualify” for CCM after their initial qualifying visit. Medicare states that patients should be seen by their provider on a “regular” basis, but “regular” is not defined. As such, we recommend seeing your active CCM patients at least once annually as best practice.

There are 6 possible CPT codes for this program:

2 Chronic Care Management (CCM) Codes:

1. 99490 – 20 minutes of CCM time
2. 99439 – 20-minute add-on
   • 99490 + 99439 for 40 minutes of CCM time
   • 99490 + 99439(x2) for 60 minutes of CCM time
     
     

4 Remote Patient Monitoring (RPM) Codes:

1. 99453 – RPM device setup (one-time code)
2. 99454 – RPM daily monitoring (device data transmission)
3. 99457 – RPM monthly monitoring (20 minutes of clinical time)
4. 99458 – 20-minute add-on
   • 99457 + 99458 for 40 minutes of RPM time

Medicare covers about 80% of the CCM services provided through our MyCare Program. Most secondary insurance policies also cover any remaining balances related to CCM.

However, depending on the patient's coverage, they may be responsible for a small out-of-pocket cost for the program. If patients can't afford their out-of-pocket cost, we recommend they call their MyCare Coordinator, who will work to find a solution, so they can stay in the program, which is recommended because:

• According to Medicare, not only do CCM programs save the healthcare system money, but they also save patients money in the long run by keeping them healthy and out of the hospital.
  
  
• Studies have shown that the long-term benefits and cost savings of participating in the programs greatly outweigh the possible small monthly expense.
  
  
• The MyCare Program allows patients to collaborate with a dedicated MyCare Coordinator each month so they can be active participants in their health care.

We base eligibility of the MyCare Program on the patient's primary coverage, so we are mainly concerned with those primary insurance denials. If there is a secondary denial, it is typically just handled the same way it is for patients without secondary coverage who have a remaining balance.

We intentionally delay sending our invoices in order to give the practice plenty of time to bill out those claims and receive that reimbursement before our corresponding fee is due. Here is our approximate invoice schedule: