Living with a chronic illness can dramatically impact a person’s quality of life, and there are an estimated four in ten people living with multiple of these conditions in the United States. Luckily, there are methods of chronic care management (CCM) that help make long-term illness care more manageable. Some of this help can include regular check-ins from healthcare providers, extra support in understanding medications, and assistance scheduling needed doctors’ visits.
There is ample evidence that CCM not only improves a patient’s quality of life, but also reduces the number of emergency room visits and repeat hospital stays for chronic illness. This can decrease the cost of healthcare related to these chronic illnesses substantially. Because of the better health outcomes and decreased cost, Medicare offers chronic care management reimbursement for the cost of CCM services.
In this section, we’ll take a closer look at:
- How chronic care management is defined by Medicare
- Typical conditions that commonly qualify
- The components of the chronic care model that Medicare coverage supports
- Common billing and coverage questions
- How healthcare facilities can implement or improve their own CCM programs
What Is Medicare Chronic Care Management?
Medicare covers the cost of CCM for most qualifying patients because it is a proven support that leads to better health outcomes and reduced overall medical costs. The purpose of chronic care management in general is to provide patients with a coordinated medical care plan that encompasses all health issues, medications, healthcare providers, and community services used.
For Medicare patients specifically, Medicare Part B provides CCM coverage for patients with two or more chronic health conditions that will last at least one year. These could include things like diabetes, heart disease, lung disease, asthma, or arthritis. This coverage will include services provided by a doctor or medical provider to help a patient navigate the complexities of living with multiple chronic illnesses.
To qualify for Medicare coverage, these services need to include:
- A care plan developed by a healthcare coordinator
- A minimum of 20 minutes a month of care support
- More coordination between your doctors, therapists, pharmacies, and other medical staff
- Phone check-ins between regularly scheduled appointments
- Access to 24/7 nurseline support for any urgent medical changes
This support is different from the care coordination benefit rendered after a hospital stay. There might be a monthly fee for this CCM service, and the cost-sharing, deductibles, and copayments/coinsurance amounts will differ by patient.
Because CCM services require a significant amount of staff time and resources, healthcare providers often struggle to meet these needs for their patients. Appropriate coding and billing for Medicare reimbursement for these services can be an additional pain point for providers. A comprehensive CCM platform like TimeDoc can help automate care planning, simplify Medicare coding, and improve staff efficiency.
Related: Is Chronic Care Management Only for Medicare Patients? →
What Conditions Qualify for Chronic Care Management?
A medical condition which will last a year or longer that causes significant harm or risk of death qualifies for CCM. A patient with two or more of these chronic care conditions qualifies for Medicare CCM reimbursement.
There are many conditions that fit this description, but the most common include:
- Cardiovascular Disease
- Diabetes
- Chronic Respiratory Disease
- Cancer
- Alzheimer’s Disease
- Chronic Kidney Disease
- Osteoporosis
- Arthritis
Is Care Management Covered by Medicare?
Yes, if a patient meets the criteria for CCM, and it is provided according to CMS requirements, this service is covered in part by Medicare Part B. Medicare Part B does have a monthly premium that will also be paid by the patient. According to the Centers for Medicare & Medicaid Services (CMS) “the standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023”. This Part B coverage also includes services like “physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A”.
Related: Does Medicaid Pay for Chronic Care Management? →
How Much Does Medicare Pay for Chronic Care Management?
For most patients who opt in to Medicare Part B and pay the monthly premium, Medicare will pay for 80% of the cost of the service, meaning the remaining 20% is paid out-of-pocket by the patient. So if a healthcare provider charges $162 for one hour of clinical staff time for a patient’s CCM, the patient would pay $32 (20%) and Medicare would reimburse the provider $130 (80%).
Learn More about Billing Chronic Care Management →
Who Can Make Chronic Care Management Calls?
CCM as covered by Medicare is not a face-to-face service, meaning a staff member will be making phone or video calls to patients. This care must be overseen by a supervising healthcare provider, like a physician, advanced practice registered nurse, or physician’s assistant. The Centers for Disease Control provides a chronic care management call script that gives staff guidance on best practices for having the most impactful conversations.
However, the actual calls themselves can be made by any care coordinator with appropriate chronic care management training. This can include internal staff from the patient’s primary care provider, or it may be done by an external company. In either case, a CCM platform facilitates these calls being made more effectively–by making planning and carrying out calls easier with appropriate technology, or by outsourcing the calls all together. TimeDoc is a platform specifically designed to make CCM programs easier to execute.
TimeDoc: We Can Help with Your Chronic Care Management Program
We at TimeDoc know how important it is for your healthcare practice to provide the best care to your patients. We also know how much time and resources are required to adequately support a chronic care management program that scales with expanding patient numbers. That’s why we created a CCM platform that:
- Automates care planning
- Maintains compliance with Medicare
- Makes documenting care coordinator time easy
- Increases staff efficiency
- Reduces time spent on Medicare billing
- Improves ROI on CCM programs
Get in touch today to make Medicare chronic care management easier tomorrow.