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  • FAQs
  • CCM FAQs

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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 QUALIFY 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

Source: CMS: Chronic Care Management Services; ICN 908188 May 2015

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