In August, we posted about Medicare’s proposals for significant increases to essential Care Management reimbursements, like Chronic Care Management (CCM) and Principal Care Management (PCM), starting in Jan. 2022.
Good news: These ~55% reimbursement increases were just finalized with the release of Medicare’s final 2022 Physician Fee Schedule.
In summary, Medicare made below increases to CCM and PCM reimbursements after re-valuing wRVUs (work relative value units) re: care management:
What does this mean for my practice’s profits?
Whether your organization uses internal staff or a full-service outsource Chronic Care Management service like CircleLink, you should expect a 2-3X increase in care management profits, even as vendor and wage costs increase with inflation.
Take for example below practice using CircleLink for care management. For 100 enrolled patients, accounting for all CircleLink’s success-based fees, profits increase 2.6X:
Note: Assumes national average reimbursements and that 65% of co-pays are collected. Per CircleLink data, assumes 40% of billable patients need 99439/extra time.
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Why did this happen?
Over the last year, Medicare reviewed the reimbursement rates with the goal of “ensuring continued and consistent access to these crucial care management services”. Medicare also acknowledged “longstanding concern about undervaluation of care management”. (2022 PFS, page 361)
As a result, CMS accepted a re-valuation of Care Management Relative Value Units, which determine rates through a complex formula, per below table:
Is your practice prepared to take advantage of these increased reimbursements for Chronic Care Management (CCM) and Principal Care Management (PCM), as well as other care management programs? (like Remote Patient Monitoring, RPM) CircleLink demystifies the reimbursement process and can assess if your practice is a fit for increasing revenue and patient health.
Find out how to take advantage of these changes in 2022. Drop us a line at email@example.com or call 844-797-8424.