Doctors may be unknowingly forgoing hundreds of millions in federal funding that would compensate them to better care for the sickest Medicare beneficiaries, and the CMS is launching a national campaign Wednesday to encourage physicians to take advantage of the funds.
The CMS has been paying physicians an average of $42 per patient per month for consulting with specialists and coordinating chronic-care services. While the program could help lower costs for treating patients with chronic issues such as dementia, heart disease or arthritis, the program, which started on Jan. 1, 2015, hasn't been used by physicians due to a lack of awareness about the care-management billing code and pushback from patients who would be on the hook for a copayment every time their physicians bill for it.
The CMS estimates 70% of Medicare beneficiaries—roughly 35 million people—have two or more chronic conditions, which would make their doctors eligible to get paid for chronic-care services. However, the agency has only received chronic-care claims for 513,000 beneficiaries as of the end of last year, shelling out $93 million in payouts.
CMS officials claim doctors have been leaving money on the table because they don't know how to bill under the chronic-care management code.
“We've heard from doctors on several occasions that they want to implement chronic-care management services into their practice, but they don't know how to get started,” Michelle Oswald, program manager for the CMS' Office of Minority Health, said during a provider town hall call about the campaign on Feb. 21.
But doctors tell a different story. Some say they aren't billing for coordinated -are services because their patients don't want to foot a 20% co-payment. Physicians must obtain permission from patients to bill for coordinated care.
Mark Rostek, a billing director for Omni HealthCare, a Florida-based physician group, told CMS officials during the town hall that his doctors want to bill for chronic care management, but have been getting pushback from patients.
“It's been horrendous here because we have multiple patients that have more than two chronic-care conditions, but they're really reluctant" because of their co-insurance, Rostek said.
But the agency's hands are tied. It cannot waive patient co-pays under Medicare without an act of Congress.
The CMS hopes its campaign will make patients and doctors aware that the financial burden on patients isn't the barrier it is perceived to be. Most Medicare beneficiaries have supplemental insurance that will cover co-pays for them.
The campaign will also highlight a series of regulatory changes made this year to incentivize billing for care management. The agency raised the reimbursement amount for the care-management code by $1 per use, and introduced three new chronic-care management codes. The codes pay more depending on the complexity of the patient's needs. The new reimbursement scale ranges from $43 to over $141.
The campaign will involve social media postings, webinars and a new campaign website with information the billing code.
The CMS will also distribute display posters and postcards to providers to share with patients that highlight chronic-care management benefits. The agency plans to release an animated video to play in doctors' offices that explains the benefits of chronic-care management services.
A CMS spokesperson did not comment on the campaign's budget.
