ELIGIBLE PROVIDERS

Physicians, regardless of specialty, advanced practice registered nurses, physician’s assistants, clinical nurse specialists, and certified nurse midwives are all eligible to bill Medicare for CCM. While the billing provider must oversee the CCM services, they are not required to be present for the work to be done.

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ELIGIBLE PATIENTS
CMS has left the ruling open to discernment by the provider. The guideline simply requires:

✓ Two or more chronic conditions expected to last at least 12 months, or until the death of the patient
✓ Chronic conditions that place the patient at significant risk of death, or acute exacerbation/decompensation

CMS maintains a Chronic Condition Warehouse with 22 chronic conditions listed to provide researchers with beneficiary, claims, and assessment data, however, it is not an exclusive list.

 

PATIENT CONSENT
In order to bill for CCM, providers must get the patient’s written consent, confirming that the following has been explained to the  beneficiary:
✓ An overview of CCM
✓ How the CCM service may be accessed
✓ That only one provider can provide CCM services at a time
✓ That information will be shared among all the patient’s providers
✓ The patient can terminate the CCM service at any point in time by revoking  consent
✓ The patient will be responsible for any associated copayment or deductibles

Once the consent form is signed, a copy must be stored in the patient’s medical  record.