Though the dollar figures aren’t big, OIG’s report on faulty chronic care management (CCM) billing should be concerning for any practice billing those codes, especially since some of the problems have no simple answers.
The report, “Medicare Made Hundreds of Thousands of Dollars in Overpayments for Chronic Care Management Services,” released Nov. 7, is based on OIG investigations of 2015-2016 CCM activity that found CMS and patients were charged a few million dollars on suspect or invalid CCM claims.
And even in this fifth year of CCM billing, certain challenges are hard to overcome. For instance, it’s still extremely difficult to be certain that your patient hasn’t been or isn’t being provided CCM by someone else, warns Andria Jacobs, chief operating officer of PCG Software in Las Vegas.
“There’s no interoperability, so they may not even know,” Jacobs says. “And patients often have dementia or are not good historians. So the internist may say, ‘I’d like to sign you up,’ and they do, and then the patient visits her daughter in Florida, and someone down there signs them up. Patients may just be happy that they’re getting calls from multiple nurses and case managers. I was a case manager and a lot of patients would say, ‘You’re the only person who calls me.’ Case managers become part of their extended family.”
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