CMS authorized a new Chronic Care Management (CCM) program that took effect in 2015 which allows primary care physicians to bill for 20 minutes of chronic care activity every month. The amount for reimbursement will vary from state to state. To help primary care physicians determine whether they can bill for CCM and become familiar with other program requirements, we’ve answered some frequently asked questions.

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What are the program requirements?

The program stipulates that patients must have multiple (two or more) chronic conditions expected to last at least 12 months or until the patient’s death. The patient must also be at a significant risk of death, acute exacerbation/decompensation or functional decline, and a comprehensive care plan must be established, implemented, revised or monitored.

Who is eligible to bill the new CCM service?

According to the CMS requirements, primary care physicians and the following non-physician practitioners are eligible to bill the new CCM service:

  • Nurse Practitioners
  • Certified Nurse Midwives
  • Physician Assistants
  • Clinical Nurse Specialists

Only one practitioner may be paid for the CCM service in a given calendar month.

What are the Patient Agreement Requirements?

Practitioners are required to inform eligible patients of the availability of and get a written agreement for the CCM service before providing or billing the service. This includes authorization for the electronic communication of medical information between the patient’s primary physician and other treating physicians or providers.

What are the CCM Scope-of-Service Elements?

The CCM service is comprehensive and helps facilitate a better patient experience. It includes the following elements:

  • A structured recording of patient health information
  • An electronic care plan addressing all health issues
  • Access to care management services
  • Managing care transitions
  • Coordinating and sharing patient information with practitioners and providers outside your practice

Some of these elements require the use of a certified EHR or other electronic technology.

What are the EHR and other electronic technology requirements?

In order to satisfy some of the CCM scope-of-service elements, CMS requires the use of a version of certified EHR that is acceptable under the EHR Incentive Programs as of December 31st of the calendar year preceding each Medicare PFS payment year.