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Chronic Care Management (CCM): Frequently Asked Questions

WHO IS ELIGIBLE TO BILL MEDICARE FOR CHRONIC CARE MANAGEMENT?

  • Only one provider can bill for CCM service per beneficiary per month
  • Eligible practitioners acting within their State licensure, scope of practice, and Medicare statutory benefit.
    • Physicians
    • Advanced practice registered nurses
    • Physician assistants
    • Clinical nurse specialists
    • Certified Nurse Midwives
  • Rural Health Clinics
  • Federally Qualified Health Centers

WHAT PATIENTS QUALITY FOR CHRONIC CARE MANAGEMENT?

  • Patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient
  • The chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

ARE THERE EXCLUSIONS?

Four types of services cannot overlap chronic care management:

  • Transitional Care Management
  • Home Health Care Supervision
  • Hospice Care Supervision
  • Certain End-Stage-Renal-Disease (ESRD)

WHAT ARE THE REQUIREMENTS FOR REIMBURSEMENT FOR MEDICARE?

  • Obtain patient’s written consent
  • Provide five specific capabilities to perform chronic care management
  • Deliver 20 minutes of clinical care time over the period of the month
    • Does not need to be face-to-face, or office-based care time
    • Medicare Beneficiary must have two or more chronic conditions

WHAT TECHNOLOGY IS NEEDED FOR CHRONIC CARE MANAGEMENT?

  • Patient’s plan of care must be captured electronically and made available on a 24/7 basis
  • Patient’s care plan information must be shared electronically, as appropriate with other providers and not by fax

**If physician determines that the patient is eligible for CCM services, physician must discuss CCM 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

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