chronic care management

Chronic Care Management (CCM) is an initiative of the Centers for Medicare & Medicaid Services (CMS). CMS recognizes CCM as a critical component of primary care that contributes to better health and care for individuals.  CCM gives patients with two or more chronic conditions additional supervision and enhanced access to their provider in an effort to keep them stabilized, if not improving.

In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.  “Non-complex” CCM and complex CCM services are reported to Medicare on a monthly basis and differ in (i) the amount of clinical staff service time provided, (ii) the involvement and work of the billing practitioner and (iii) the extent of care planning performed.

CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM.  CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the
billing practitioner), subject to applicable State law, licensure, and scope of practice. The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.

What do you need to do to qualify for the CCM incentive? Your practice must comply with CMS’ Chronic Care Management Services guidelines, including enhanced record keeping and reporting.  

If you need assistance with implementation or maintenance of CCM for your practice, we can evaluate your practice’s current capabilities and help coordinate the most efficient, cost-effective, CCM program available to you.