Medicare now reimburses physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

This 25-page resource draws from the 2015 Medicare Physician Fee Schedule to identify new sources of payment for physician practices while improving care coordination for beneficiaries with chronic illness.

Subject matter expert Rick Hindmand, attorney with McDonald Hopkins, a law firm advising clients nationally on healthcare reimbursement, provides a roadmap to obtaining payment for Medicare Chronic Care Management (CCM), covering such key issues as beneficiary eligibility, scope of chronic care services, system requirements, documentation, compliance issues, and more.

While geared to providers coordinating care for Medicare beneficiaries, the CCM framework suggests a practical approach to care coordination for Medicaid beneficiaries, the dually eligible and the privately insured, based on the likelihood that commercial payors will offer similar rewards for care coordination of chronic illness.

In Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities, Hindmand reviews the following CCM payment guidelines:

• Medicare beneficiary eligibility;
• Six elements under scope of chronic care management services;
• Care plan provisions;
• Supervision requirements for clinical staff providing CCM services;
• Electronic health record (EHR) requirements for CCM reimbursement;
• Billing requirements;
• Beneficiary disclosure and consent;
• Documentation guidelines;
• Compliance issues;

Table of Contents

• Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination
  • Overview of Chronic Care Management Program
  • Justification for CCM
  • Beneficiary Eligibility
  • 6 Elements of CCM Services
  • Supervision of CCM Staff
  • Electronic Health Record Requirements
  • Beneficiary Consent and Limitations
  • Billing Requirements
  • Documentation of CCM Services
  • Compliance Concerns
• Q&A: Ask the Experts
  • Chronic Care Management Lessons for Private Payors
  • Patient Visit Requirements
  • Designated Chronic Care Management Provider
  • Addressing Issues on the Problem List
  • Billing Criteria
  • Patient Eligibility for CCM Services
  • Mental Health and Chronic Condition Definitions
  • CCM Eligibility for ACOs and MSSP
  • Dual Eligibles Participation
  • Care Plan Distribution Requirements
  • Defining Clinical Staff Members
  • Provider Management of Chronic Conditions
  • FQHC Reimbursement
  • Licensure for Clinical Staff
  • Fee-for-Service Versus Medicare Advantage Beneficiaries
  • Third-Party Services
  • Appropriateness of Advance Beneficiary Notice
  • Considerations for Non-Licensed Staff
  • Medicare Transitional Care Management
  • Impact on Provider-Patient Communications
• Glossary
• For More Information
• About the Contributor