Frequently Asked Questions
What exactly is the CCM requirement?
Chronic Care Management services require at least 20 minutes of non-face-to-face clinical staff time directed by a physician or other qualified health care professional, per calendar month.
That 20 minutes of time requires: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of functional decline, exacerbation/decompensation or death. A comprehensive care plan must be established, implemented, revised and/or monitored.
Will you treat my patients like I treat my patients?
Absolutely. We approach our patient engagement as an extension of your practice and patient care team.
Does this follow Medicare’s physician supervision requirements?
Yes. CMS provided an exception under Medicare’s “incident to” rules specifically for CCM services. This that permits clinical staff to provide the CCM service incident to the services of the billing physician (or other appropriate practitioner) under the general supervision (rather than direct supervision) of a physician (or other appropriate practitioner).
What must be provided to beneficiaries prior to CCM eligibility?
CMS requires the billing practitioner to furnish an Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE) or comprehensive evaluation and management visit to the patient prior to billing for the CCM service, and to initiate the CCM service as part of this exam/visit.
Does ProfitableMD use a certified EHR?
Yes. ProfitableMD uses a Meaningful use Stage 2 certified EMR
How does the 20 minute non-face-to-face visit work?
We coordinate a mutual time to speak with the patients. At that time, our staff contacts each patient on the phone and spends 20 minutes every month discussing their care plan and progress toward the patient’s individual healthcare goals.
Who is eligible to participate?
Regardless of specialty, any Medicare-Credentialed Physicians, Advanced Practice Registered Nurses, Physician Assistants or Clinical Nurse Specialists are eligible to bill Medicare for CCM.
At this time, other Non-Physician Practitioners and Limited License Practitioners (e.g., Clinical Psychologists, Social Workers) are not eligible.
Can more than one provider bill for CCM?
No. CMS will pay only one claim for CCM, per beneficiary, per calendar month.
Are there any exceptions to a patients eligibility for CCM services?
Yes. There are four types of services that cannot overlap with CCM services on the same day.
- Certain ESRD codes 90951-90970
- Home Healthcare Supervision code G0181
- Hospice Care Supervision code G0182
- Transitional Care Management codes 99495 and 99496
Is my patient responsible for any payment?
As with any other billable code, the patient is responsible for deductibles, copayments and remainder amounts according to the patient’s insurance coverage.
Unfortunately CCM 99490 is not exempt from cost-sharing rules. So Medicare Part B patients with no secondary coverage will be responsible for approximately $8/month.