Care Management (CM): Frequently Asked Questions
WHAT IS CARE MANAGEMENT (CM)?
Care Management (CM) provides coordination of care for patients suffering from two or more chronic conditions that are expected to last at least 12 months. The service includes at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, and does not have to be face-to-face (in person). That means part of that time could be spent on the phone, secure messaging, secure Internet, or through some other form of secure HIPAA compliant communication.
WHY SHOULD I ENROLL IN A CM PROGRAM?
CM can help patients with chronic diseases to stay out of the hospital or emergency room and can help prevent complications by managing your health care. CM works to coordinate care among different providers such as specialists, surgeons, pharmacists, and others. It is a way to keep your physician and all related health care providers connected and informed about all aspects of your care.
The NavCare CM program helps you and your caregiver to keep track of your own health care by accessing your health care information through a secure online platform.
You will have access to care management services 24-hours a day, 7-days a week.
HOW CAN I ENROLL IN THE CM PROGRAM?
Your doctor will explain the CM program to you and will ask you to complete a form providing written consent to enroll in the program.
WILL MY INSURANCE PAY FOR CM?
Beginning January 1, 2015, Medicare began paying for care coordination services furnished to Medicare beneficiaries with multiple chronic conditions under the Medicare Physician Fee Schedule. CM is not exempt from cost-sharing requirements, so co-payments and deductibles apply.
Some commercial insurance companies also pay for CM.
**If physician determines that the patient is eligible for CM services, physician must discuss CM services with the patient during their Annual Wellness, Initial Preventive Physical Exam, or Comprehensive Evaluation and Management visit.
Source: CMS: Chronic Care Management Services; ICN 908188 May 2015