Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services (CMS) did not make new requirements for CCM services. Rather it restated the criteria spelled out in the 2014 fee schedule rule. Check out the criteria you must meet from the list given here.

1) 24/7 access to care management services. 

2) Continuity of care (aka successive routine appointments available for the patient with a designated practitioner).

3) Care management for chronic conditions including: 

    a. Systematic assessment of patient’s medical, functional, and psychosocial needs,
    b. System-based approaches to ensure timely delivery of preventive care services,
    c. Medication reconciliation with review of adherence and potential interactions, and
    d. Oversight of patient self-management of medications.

4) A patient-centered care plan document congruent with patient choices and values (plan is based on a physical, mental, cognitive, psychosocial, functional and environmental assessment and an inventory of resources and supports).

5) Management of care transitions among health care settings, including referrals and follow-ups.

6) Coordination with home- and community-based clinical service providers to support the patient’s psychosocial needs and functional deficits. 

7) Enhanced opportunities for the patient and caregiver to communicate with the provider — telephone as well as secure messaging, Internet, or other asynchronous non-face-to-face consultation methods.

8) Use of certified electronic health record (EHR) or other health information technology or health information exchange platform that includes an electronic care plan accessible to all providers within the practice. Must include access to those furnishing care outside of normal business hours and have ability to be shared electronically with care team members outside of the practice.