Getting patient consent for chronic care management

In January, the new chronic care management code took effect, which allows physicians to be reimbursed for some of the non-face-to-face time spent coordinating care for patients with 2 or more chronic conditions. This is a great opportunity for internists to bill for care they may have already been providing for free, or to provide care patients would otherwise have had to come into the office to receive.

Medicare will now reimburse for chronic care when the practice spends at least 20 minutes of time coordinating care for patients between visits. The goal is to keep these patients with multiple chronic conditions as healthy as possible by providing coordinated care among all clinicians and settings. There are a variety of approaches, but some practices are developing a chronic care program to care for their sickest patients.

The non-face-to-face time must be “contact based,” meaning that the patient has to be included somewhere in the care, for example, with a call to the pharmacist, with a call regarding lab results, or with a call to or from a specialist who saw the patient. In-person encounters and preventive care such as the Annual Wellness Visit will be billed separately.

The patient must receive a written or electronic care plan, and anyone who provides non-face-to-face care, either the designated clinician or a contracted employee or covering clinician, must have electronic access to the care plan 24/7 for the time to count. Only 1 person can bill for chronic care management in any given month, so it is important that patients only sign up with 1 physician.

While the practice may use a care manager or other clinical staff such as nurses, medical assistants, and other appropriately trained staff to help manage the care, the patient has an important role on the care management team. It is critical that the patient understand what the program involves, what it does and does not include, what his or her rights are in the program, what the billing responsibilities are, and other parameters.

No matter how each practice sets things up, the patient must give written consent to participate. ACP has developed a step-by-step toolkit that practices can use to implement chronic care codes, including the critical element, a sample patient letter/consent form. There are a few things that the consent must include:

• Patients will receive a written or electronic care plan;
• They can decline, transfer, or terminate at any time;
• They authorize electronic communication of medical information with other clinicians (as allowed by state and local rules and regulations);
• They consent to being billed for their share of the Medicare fees;
• They acknowledge that only 1 practitioner at a time can provide chronic care management services; and
• Most important, they consent to participate in the program.

For access to the Chronic Care Management Tool Kit and the sample patient agreement, go to ACP's Running a Practice website.