Chronic Disease Management Tariffs (CDM)

Note: In April 2017 Comprehensive Management Tariffs (CCM) will be introduced for care of patients with chronic diseases. Physicians may bill either CDM or CCM tariffs for those patients. For information see CCM Tariffs.

Chronic Disease Management tariffs remunerate general practice physicians who provided the majority of a patient’s ongoing comprehensive care in relation to the active management of specific chronic disease(s) during the preceding 12 months. Specifically, these tariffs and chronic diseases are as follows:

Tariff Description Rate
8431 Annual Management of Diabetes $45.00
8432 Annual Management of Asthma $20.00
8433 Annual Management of Congestive Heart Failure $45.00
8434 Annual Management of Coronary Artery Disease $45.00
8435 Annual Management of Hypertension $45.00

This article will provide you with answers to two important questions:

  1. When am I eligible to bill these tariffs?
  2. How do I bill these tariffs?

When am I eligible to claim a CDM tariff?

In order to bill a CDM tariff a physician must meet all eligibilty requirements stipulated in the tariff  More specifically,  a physician must:

  1. be a general practice physician;
  2. provide the majority of the patient’s ongoing comprehensive care in relation to the active management of the specific chronic disease(s) diagnosed;This means that only one physician may bill for this patient in each 12 month period.
  3. have provided that care during the preceding 12 months;These tariffs can be billed for care and management provided in the previous twelve (12) month period.  This means that you may bill for the care that you are currently providing this patients if all other requirements are met. Physicians must have seen the patient at least once in the previous 12 months to claim.Each tariff may only be claimed once in any 12 month period.
  4. provide ongoing coordination with other allied health care providers repsecting the management of the patient’s condition and patient care plan as appropriate;
  5. provide ongoing communication with the patient, monitoring of the patient’s condition and patient care plan as appropriate; and
  6. provide all of the required services for the particular tariff as listed below.  Such services must be recorded in the patient’s chart and, where indicated, on the Patient Care Treatment Form that is to be submitted to Manitoba Health.
Asthma:

For asthma patients, physicians must develop and review an Asthma Action Plan.  The Asthma Action Plan is available from the Canadian Asthma Society website at:

http://www.asthma.ca/adults/control/actionPlan.php

Billing tip:

Remarks on the claim advising the Asthma Action Plan was completed are sufficient for billing purposes.  Retain a copy of the action plan in your files for audit purposes.

 

Congestive Heart Failure Coronary Artery Disease Diabetes
Blood pressure measurement Blood pressure measurement Blood pressure measurment
Obesity/overweight screening Obesity/overweight screening Obestiy/overweight screening
Full fasting lipid profile screening (only for patients from 18 to 74 years of age) Full fasting lipid profile screening (only for patients from 18 to 74 years of age) Full fasting lipid profile screening (only for patients from 18 to 74 yeras of age)
Fasting blood sugar test (not required for patients with diabetes) Fasting blood surgar test (not required for patients with diabetes) Foot examination or management of documented peripheral neuropathy
Management of ACE inhibitor or ARB use. Management of beta blocking medication (patients aged 18 to 74) who have had an acute myocardial infarction, do not have asthma and have been prescribed with a beta blocking medication Fundoscopic examination or referral for a fundoscopic examination

 

Lipid reduction counseling (patients aged 18 to 74) with LD levels of greater than 2.0 mmol/L or prescribed with lipid lowering medication HGB A1C test, Nephropathy screening

Where a patient is treated for the management of more than one of the listed diseases a tariff may be billed for each disease.

Claims for addition services (e.g. visits) are payable in addition to these tariffs.

How to Bill for Chronic Disease Management Tariffs

Below are details to assist you with billing these tariffs.

Q:  Am I required to submit a separate claim for each Chronic Disease Management (CDM) tariff associated with a single patient?

A: Yes.  A separate claim needs to be submitted for each CDM tariff claimed.  For example, two (2) separate claims must be submitted when billing CDM tariffs for both Diabetes (8431) and Coronary Artery Disease (8434) for a single patient. The ICD code for each claim must match the disease.

Q: How do claim submissions for the CDM tariffs (8431, 8432, 8433, and 8434) differ from my other claim submissions?

A: Claims for the CDM tariffs should be submitted through your normal claims submission process.  The difference is that these tariffs also require supporting information with respect to the management of the patient’s disease. 

Q: What additional information do I need to submit when claiming Tariff 8432 for Asthma? 

A: Claims for Tariff 8432 – Asthma – require a remark on the claim stating “Asthma Action Plan completed”

Q: What additional information do I need to submit when claiming all other CDM Tariffs? 

A: Claims for all other CDM tariffs must be accompanied by a completed Patient Care Treatment Form

Q What is a Patient Care Treatment Form and where can I get them?
A Patient Care Treatment Forms are forms designed by Manitoba Health to assist physicians in providing the information required to bill these tariffs.  When completed they will provide Manitoba Health with the evidence required to demonstrate that all required services have been provided.
The forms may be downloaded from
a Electronic Practitioners integrated Claims Submissions (EPiCS) System on the Secure Internet Solutions (SIS) application Portal
b Government of Manitoba Web site:
www.gov.mb.ca/health/chronicdisease/cdmtariffs.html

Q: How do I submit the Patient Care Treatment forms?

A Forms must be submitted to Manitoba Health as follows:
Mail or drop off: 
Manitoba Health
Rm. 3066 – 300 Carlton Street
Winnipeg,  MB R3B 3M9

Q: When should I submit the Patient Care Treatment Forms?

A: It is recommended that you submit the Patient Care Treatment Forms on or around the same date that you submit your CDM claim(s) for the patient.

Q: Can I use my EMR to submit the information on the Patient Care Treatment Forms?

A: Yes Manitoba Health has  implemented systems that enables physicians with certain EMRs to provide data extracts that pull information directly from the patient record and alleviate the need to manually re-enter information on Patient Care Treatment Forms.   If you provide Manitoba Health with monthly data extracts you do not need to submit forms.  For further information contact your software vendor or e-Health.

See article on Comprehensive Care Management tariffs.

Questions?

Roger Jamieson
rjamieson@doctorsmanitoba.ca
(204) 985-5849

 

 

Updated: April 2018