LITTLE ROCK, ARK. - The Case Management Society of America (CMSA) has formally requested that the Centers for Medicare & Medicaid Services (CMS) revise a recent ruling and make a number of care coordination services payable under CMS.

An interim final rule by CMS provided certain assessment and care coordination codes which were assigned Relative Value Units (RVUs) but were deemed an "N" status, making those codes ineligible for Medicare reimbursement. CMSA is concerned that failure to provide financial reimbursement for these practices continues to misalign incentives and priorities that will negatively impact care delivery to patients.

"Currently, case managers work in a collaborative manner with physicians, pharmacists, and other care managers, such as social workers, to best coordinate patient care between different professionals and different practice settings," explained CMSA Director Teri Treiger, RN-C, MA, CCM, CCP, CPUR. "Without the appropriate financial funding for these types of services, healthcare providers have less incentive to provide this type of coordination, and many cannot afford to fund such initiatives on their own. Poor coordination leads to poor transitions of care in our system, not only resulting in the patient receiving less than the best care possible, but possibly in very dangerous situations occurring, such as incorrect treatments, medication errors, and delay in diagnosis and treatment."

In a formal letter from the CMSA Board of Directors to CMS, CMSA explained that inadequate care coordination can result in higher patient readmissions, poor patient care leading to more patient complaints, and an overall increase in healthcare costs. CMSA has formally requested that CMS reconsider the interim payment rule on several Current Procedural Terminology (CPT) codes (99441, 99442, 99443, 98966, 98967, and 98968) and change these codes from an N Status to Medicare payable codes. These codes would incentivize a variety of assessment and management services to beneficiaries, such as:

• Transition of care coordination
• Medication reconciliation
• Health literacy, patient medication knowledge
  and patient readiness-to-change assessments
• Motivational interviewing
• Patient education
• Medical home coordination

In conjunction with the formal letter, CMSA is reaching out to other organizations within the care management industry asking them to support the coding change. "It is essential that all care managers — nursing case managers, social workers, disease managers, physicians, pharmacists, and others — bind together to support this important modification to the way CMS reimburses companies for providing the best coordinated care possible," said CMSA President Peter Moran, RN,C, BSN, MS, CCM. "This change will help every care manager provide better, more effective service to their patients, control costs for their organizations, and incentivize their companies in dedicating resources to solving care coordination issues."

CMSA has sent information to its 10,700 members asking them to support the change in CPT coding. The association has made several resources available on its website to assist members and non-members care managers in advocating for this change. Interested parties can also directly communicate with CMS by posting to their public comment forum here. Other organizations who are interested in supporting the change to CPT coding should contact CMSA to learn more.