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.
- 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