Care Management Medicare Reimbursement Strategies for Rural Providers
The Centers for Medicare & Medicaid Services (CMS) provides payment for services intended to keep Traditional Medicare patients healthy and better coordinate services to support patients at home. These services can also support rural hospitals, Rural Health Clinics, Federally Qualified Health Centers, and practitioners participating in value-based care programs and alternative payment models by helping improve quality of care and health outcomes.
Each of the guides below provides a brief overview and links to key documents to help rural healthcare professionals, practices, and hospitals understand the billing code, consider the benefit to their patients and organization, and begin billing Traditional Medicare for the code. These guides include:
- Annual Wellness Visits: Yearly visit to review a patient's medical and social history and provide counseling about preventive services.
- Initial Preventive Physical Exam: The “Welcome to Medicare” visit for patients who are new to Medicare.
- Chronic Care Management: Monthly non-face-to-face support for patients with two or more chronic conditions.
- Principal Care Management: Monthly non-face-to-face support for patients with a single high-risk disease.
- Behavioral Health Integration Services: Care management provided primarily in a primary care setting for patients with behavioral health needs. Also includes information about the Psychiatric Collaborative Care Model (CoCM).
- Transitional Care Management: Certain non-face-to-face services and face-to-face visit for patients in the 30 days after discharge from an acute care setting.
- Social Determinants of Health Risk Assessment: Assessment of a patient's unmet social needs using a standardized, evidence-based tool.
- Community Health Integration Services: Services to address unmet social needs affecting diagnosis and treatment of medical conditions.
- Principal Illness Navigation Services: Services to support patients with high-risk conditions access resources for health and social needs.
- Caregiver Training Services: Education provided to a patient's caregiver related to support for the patient's physical and/or mental health.
- Marriage and Family Therapists and Mental Health Counselors Billing: New rule allowing MFTs and MHCs to bill Medicare independently for their services furnished for the diagnosis and treatment of mental illnesses.
More information on care management can also be found on the Care Management section of the CMS website.
Last Reviewed: 11/26/2024