Required Elements of CMS compliant CCM program
Multiple requirements exist to bill CCM. The requirements are complex and address patient’s eligibility, provider eligibility and billing components.
One must manage care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and followup after discharges from hospitals, skilled nursing facilities, or other health care facilities.
Care manager must also coordinate and communicate with home- and community-based clinical service providers. Furthermore, CMS states that care management for chronic conditions including systematic assessment of the patient’s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of patient self-management of medications
CPT 99490 describes activities that are not typically or ordinarily furnished face-to-face, such as telephone communication, review of medical records and test results, and consultation and exchange of health information with other providers.
Activities that are appropriate for CCM are (not all inclusive list):
- Assessment of needs (functional, psychological, psychosocial, SDOH, instrumental, environments, care giver and more)
- Coordination of Care
- Communication with provider
- Communication with patient and or caregiver
- Communication with any providers involved in care (specialists, HHA, DME, Pharmacy)
- Patient education
- Chart Review
- Medication management (reconciliation, education, help in obtaining, adherence and more)
- Identifying and Managing Gaps in Care (preventative services, maintenance appointments)
- Identifying deficiency and Managing Self- Care
- Empowering patient to get involved in care
How Can We Help
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