Watch out on double-booking CCM as CMS guides hospitals in proposed OPPS rule

Why This Topic Matters

The topic matters because the proposed guidance could affect how hospitals and practices coordinate chronic care management claims and avoid billing the same patient more than once. Understanding the policy scope helps reduce claim conflicts, patient confusion, and potential payment or compliance issues.

Article Sections

1. Chronic care management and proposed hospital billing guidance

   Introduces CMS guidance in the proposed outpatient payment rule and places it in the context of chronic care management billing. It outlines the general hospital and outpatient setting issues addressed by the article.

2. Potential overlap between hospital and physician claims

   Discusses how hospital and physician billing activity can intersect for the same patient. The section emphasizes coordination concerns and the broader risk of duplicate claims in different care settings.

3. Operational steps to reduce duplicate billing risk

   Reviews suggested workflow and communication practices for tracking patient touchpoints and keeping hospitals and practices aligned. It focuses on operational monitoring rather than code-specific instructions.