decisionhealth Newsletters, Part B News - 2015 Issue 3 (March)
CMS requires face-to-face visit before billing CCM, suggests obtaining consent then
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Article Overview
This article covers Medicare guidance affecting chronic care management (CCM) billing, including when a patient encounter should occur before CCM is furnished or billed, how informed consent is addressed, and a few related compliance points for care coordination. It is useful for physicians, billing staff, practice managers, and ACO participants who need to understand the general requirements and common pitfalls associated with CCM claims.
Why This Topic Matters
CCM claims can be denied if the required prior visit and consent/documentation steps are not handled correctly, so practices need to understand the general Medicare expectations before billing.
Article Sections
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Face-to-face visit expectation before CCM
Introduces Medicare’s expectation that CCM be initiated after a qualifying patient encounter and notes that denials may occur when the prerequisite visit has not been completed.
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Best practice: Get informed consent at visit
Summarizes CMS discussion of informed consent timing, documentation, and the general purpose of using a routine visit as an opportunity to address CCM enrollment.
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2 more tips to bill CCM correctly
Covers additional CCM billing topics discussed by CMS, including care record transmission methods and considerations for practices associated with ACOs.
What You Will Learn
- The general Medicare framework for starting CCM services
- How CMS addresses the relationship between a prior visit and informed consent
- Broad documentation and electronic transmission considerations tied to CCM
- General billing considerations for practices connected to ACOs
Who Should Read This
- Physicians
- Billing staff
- Coding professionals
- Practice managers
- Care coordination staff
- ACO participants
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