Billing Guidelines for Chronic Care Management

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Billing for chronic care management is an important topic that many practices are not aware of. Chronic care management, also known as CCM, refers to the coordination and delivery of long-term healthcare services with a focus on improving patient’s quality of life. The following guidelines will walk you through how your practice can bill for this service.

What is Chronic Care Management

Chronic care management is a process that involves coordinating, planning, and monitoring an underlying medical condition for individuals who have multiple or complicated health issues. The goal of chronic care management is to improve the quality of life for these patients so they can function better in their daily lives. This role may be performed by registered nurses, licensed practical nurses, social workers, home health aides, or other allied health professionals.

The importance of billing guidelines for chronic care management

All payers such as Medicare, Medicaid and commercial insurers required CPT codes when the coding physician ordered chronic care management services. If these codes are not used to report the service without an appropriate modifier attached, the claim will be denied during initial processing. It is important to use current and accurate coding guidelines that are specific to the type of chronic care management service (such as initial, established patient follow-up visits, etc.) and all modifiers required by your payers. The CPT coding guidebook contains information on an extensive list of modifiers for each chronic care management service.

How to ensure proper CCM Billing?

The first step is to make sure that the practitioner performing chronic care management services is appropriately credentialed for the service. The practitioner must meet the payer’s requirements for certifying eligibility, submitting claims, and receiving payment. Many programs have a medical director who makes decisions about patient management or provides clinical oversight of chronic care management teams. The medical director will also determine the appropriate billing codes for your chronic care management services. You should discuss all aspects of your program with this person, so he or she can properly review the CPT coding guidebook and identify which modifiers to use when submitting claims.

Who does billing for chronic care management?

Many practices have a coder who is responsible for billing and coding, along with other things like scheduling patient appointments, reviewing their electronic medical record (EMR) system for insurance eligibility information, collecting copays/coinsurance amounts that are due from patients at each appointment, and collecting any mailed payments. Consult professional companies that provide CCM services that will monitor your compliance with coding, billing, and collection of copays.

The most important part while considering How to Implement Chronic Care Management is that chronic care management billing practices are ACCURACY. If the CPT code for chronic care management services used by the practice is not accurate, it could ultimately deny claims submitted on behalf of patients.

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