ED Coding & Reimbursement Alert - 2020 Issue 6
Care Management: Take Care to Cultivate CCM in Your Practice
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Article Overview
This article covers how chronic care management programs are structured and maintained in a practice setting, with attention to Medicare-related billing concepts, documentation expectations, patient consent, and time tracking. It is aimed at physicians, QHPs, coders, billers, and practice managers who want a high-level understanding of care-management program requirements and related service categories. The article also discusses how multiple care-management service types fit together and which broad kinds of activities may or may not be counted toward reported time.
Why This Topic Matters
Care-management services can create new revenue opportunities while supporting patients with chronic or high-risk conditions, but they also require careful attention to documentation, consent, and service selection. Understanding the overall framework helps practices build compliant workflows and avoid overlapping reporting issues.
Article Sections
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Know What Goes Into CCM
Introduces the general components of a chronic care management program, including patient eligibility concepts, documentation expectations, consent, and time-based reporting. The section also references Medicare and the related CPT and HCPCS framework.
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Know How to Handle Patients With Single or Complex Conditions
Discusses how care-management services may differ for single high-risk conditions versus more complex chronic care scenarios. It also covers the broader context for newer Medicare-focused care-management options and time thresholds.
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Know What Activities Count, or Don’t Count, in a CCM Program
Reviews categories of work that may be included in or excluded from care-management time calculations. The section also notes related services that can overlap with other reporting categories.
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The Final Word
Provides a brief closing perspective on the relevance of chronic care management for practices with Medicare populations.
What You Will Learn
- How chronic care management programs are generally organized
- What broad documentation and consent topics are associated with care management
- How time-based reporting is discussed for CCM and related services
- Which general categories of activities may be included or excluded from care-management time
- How practices can think about care-management offerings for chronic or high-risk patients
Who Should Read This
- Physicians
- Qualified health care professionals
- Medical coders
- Medical billers
- Practice managers
- Care coordination staff
Codes Discussed
Code Ranges Discussed
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