CMS Chronic Care Management Best Practices for 2025

Course Description

CMS adding more codes and adding new concepts like Principal Care Management, fees increment etc. for the effective care management. Chronic Care Management (CCM) has become a hugely profitable endeavor for many healthcare providers. More vendors are coming to the “playground” with their software, clinical teams, and billing capabilities. Providers must be more vigilant in choosing CCM vendors because the billing is always done under providers making them accountable for everything the vendor is doing. Understanding compliance, knowing best practices, and starting off appropriately is essential for a Chronic Care Management program to be effective, compliant, and efficient.

This webinar will outline guideline changes as well as revisions made by the CMS. This session will highlight what is needed to keep providers compliant with billing Chronic Care Management services. We will discuss the new principal management code and how that plays into the care of patients. These codes will be discussed as CMS recognizes chronic care as a critical component of care that contributes to better health and care for those we serve. Expert Dr. Irina Koyfman, DNP, NP-C, RN, will review the latest CMS Medicare’s changes in care management, Federally Qualified Health Centers (FQHCs), preventive care, behavioral health services and telehealth; and also guide you to how to be proactively compliance with these changes. These changes in physician payment policies can impact your practice’s reimbursement and payment systems.

Learning Objectives

• To verbalize key component of CCM
• To summarize evaluation plan
• To identify what is needed for the Implementation Plan
• Review CMS’s Chronic Care Management (CCM) and Principal Care Management (PCM) requirements
• Examine the Scope of Services required to bill Medicare for CCM services
• Identify how CCM can close care gaps and engage patients
• Assess the financial and quality implications of incorporating CCM in your practice
• Recognize the importance of CCM in relation to quadruple aim

Areas Covered in the Session

• Sobering Statistics
• History of CCM
• What is Chronic Care Management
• CCM Activities
• Patients Eligibility
• Examples of Chronic Conditions
• Provider Responsibility
  - Face-to- Face Visits ( within 12 month)
  - Consent
  - Establishing, Revising and Providing pt with a Comprehensive Care Plan
  - Designated care team member
  - Certified EHR
  - 24/7 coverage
• Initiating Visit
• Consent
• Comprehensive Care Plan
• Billing
• Who can bill for CCM?
  - Physicians and Non-Physician Practitioners (NPP)
  - Certified Nurse Midwives
  - Clinical Nurse Specialist
  - Nurse Practitioners
  - Physician Assistants
  - RHC and FQHC
  - Hospitals & Critical Access Hospitals
• Who can not bill for CCM?
  - Clinical psychologists
  - Podiatrists
  - Dentists
• Who can provide CCM
• Clinical Staff
  - CPT Definition
  - CMS Definition
• Know the Rules
  - Transitional Care Management (CPT 99495 and 99496)
  - Home Healthcare Supervision (HCPCS G0181)
  - Hospice Care Supervision (HCPCS G0182)
  - Certain End-Stage Renal Disease (ESRD) services (CPT 90951- 90970)
• Bonus Codes for Specialists
• Principal Care Management (PCM)
• Reimbursement Opportunities
• Benefits of Implementing CCM
• Case Manager Case Load
• Pros and Cons of Outsourcing CCM
• Tips for outsourcing success
• CCM Platforms Overview
• What to look for in the software
• Pros and Cons of Using EMR for CCM
• Best Practice
• FAQs
• Live Q&A Session

Suggested Attendees

• Nurses
• Doctors
• Nurse Practitioner
• Population Health Officers
• Innovation officers
• CNO/ CMO
• Billers
• Physicians
• PCP (MD, NP, PA)
• Specialists (MD, NP, PA)
• Nurse Managers
• C-Suite Healthcare Executives

About the Presenter

Dr. Irina Koyfman, DNP, NP-C, RN, is a Nurse Practitioner and a Doctor of Nursing Practice with 25 years of nursing and 15 years of executive experience. Dr. Koyfman is an expert in the Patient-Centered Medical Home (PCMH), Home Health, Healthcare Start-ups, Transitional Care, Community Health, Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Care Coordination. Dr. Koyfman is a dedicated and enthusiastic clinician with an entrepreneurial drive. She has a history of establishing 4 successful healthcare ventures, where she drove significant operational growth (up to1,000%), built successful teams with high retention rates, and improved patient satisfaction and patient outcomes. She is a Subject Matter Expert in CCM and RPM, making her a frequent presenter at multiple conferences. As a founder of Affinity Expert, a healthcare consulting company, she has been consulting primary care providers on all aspects of CCM and its successful clinical, operational, and financial implementation. She has created a growing community of clinicians through her CCM/RPM groups on Facebook and LinkedIn where she provides free information and education to providers. She loves to give back and volunteers on multiple boards along with hands on volunteer work.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: [email protected]

Address:- 651 N. Broad Street, Suite 206, Middletown, DE 19709

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"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

All tickets include recording of the event.

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