CMS to Pay for Care Coordination

CMS to Pay for Care Coordination

CMS to Pay for Care Coordination

CMS to Pay More for Care Coordination

CMS to pay for more care coordination. Doctors in 2017 will be paid more for care coordination, disease prevention and mental/behavioral health care services.

Under the final physician fee schedule the Centers for Medicare and Medicaid Services has allocated an additional $140 million on these services. It is estimated that fees for these services could reach $4 billion, according to CMS Acting Administrator Andy Slavitt. Clinicians will be paid more for coordinating patient care and spending more time managing their patients beyond the office visit. CMS is recognizing in their payment codes primary care, care management and cognitive services. Under the revised payment system additional fees will be available to physicians for non-face-to-face prolonged evaluations and care management. Chronic care management of complex patients and for patients with cognitive issues such as dementia can now be billed under a separate code. This reflects CMS’s understanding of the time and additional responsibility these physicians are putting into managing the overall care of their patients.

These changes and the recognition of the time necessary to case manage this group of patients will lead to much better patient outcome, more and better information and access to services. Individuals and their families will finally have access to critical care and support services that can improve their quality of life.

CMS has now recognized in a real way behavioral care management. Separate payments for primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions, including care coordination between psychiatric consultations and behavioral health specialists.

Family practice, Geriatricians, and Internists will be the provider of core services for the Medicare program, as well as providing the additional care coordination and leadership role these new regulations a reimbursements require. It is estimated that these new reimbursements attributed to the new codes will be between thirty percent (30%) and thirty seven percent (37%) depending on the specialty.

CMS is finally seeing the primary care physician as best suited to be the coordinator and gate keeper of care for Medicare patients.

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