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Survey: Many PCPs Unaware of Certain Medicare Reimbursements

October 2, 2015
by Rajiv Leventhal
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Many primary care physicians are not aware that they can be reimbursed for non-face-to-face time with Medicare patients who have two or more chronic conditions, according to a recent survey from Dallas-based SmartCCM, which specializes in providing third-party chronic care management services.

The survey, which included 500 primary care physicians who treat Medicare patients, reports 63 percent of primary care physicians cite the lack of time to provide the extra guidance and reinforcement that chronic care patients require to understand their treatment plans as one of their top-two challenges in working with this patient population.

 Indeed, 46 percent of PCPs who were surveyed reported that they didn’t know that they can be reimbursed for non-face-to-face time with Medicare patients who have two or more chronic conditions. SmartCCM’s software automatically bills Medicare and performs all reconciliation for services under CPT code 99490 for non-face-to-face care coordination services on the physician's behalf.

Additional findings from the survey include:

  • Fifty-six percent cite the complexity of managing multiple conditions as one of the top-two challenges in caring for this population
  • Thirty-eight percent of physicians do not contact their Medicare patients with two or more chronic conditions between office visits.
  • When it comes to compliance with a specific care plan, the physicians characterize three-quarters of their Medicare patients with two or more chronic conditions as only “somewhat compliant.”

“Knowing that chronic care patients are a significant part of the population— and a group that has additional needs—it is critical that physicians find ways to regularly monitor their wellness and compliance,” Andrew Baumiller, CEO of SmartCCM, said in a statement. “The insights from this survey show that physicians are deeply invested in patient care, but need assistance in implementing CPT code 99490.”

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