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2018 Big Winners in the Medicare Chronic Care Management Program Rulings: How FQHCs, RHCs and other Provider Organizations Are Impacted

Chronic Care Management continues to be a valuable and effective tool in the race to manage chronic health conditions and disease. Though CMS continues to refine requirements, they recognize that Medicare Chronic Care Management (CCM) is an important component in a comprehensive program designed to provide quality care and deliver improved healthcare outcomes.

In 2018, Federally Qualified Health Centers (FQHCs) and Regional Health Clinics (RHCs) are the big winners and most affected by the changes made in the CMS rulings. The main thrust of the updates is to enhance payment and simplify billing procedures. In fact, CMS is no longer accepting CPT Code 99490 from these entities, and instead FQHCs and RHCs are required to bill either of these two new established HCPCS codes (GO511 and GO512) for all chronic care services provided. More good news is that for these groups, FQHCs and RHCs, there were no changes to the program requirements.

To get a more thorough understanding of Medicare CCM program requirements for FQHCs, RHCs and other Providers, please download our 2018 Chronic Care Management eQGuide including a summary of reimbursement rates, chronic care management service elements and billing requirements. Additionally, we provide web links for CMS content related to the CY 2018 PFS Final Rule Revisions, the CMS CCM Fact Sheet, and the most up to date CCM FAQs.

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