IN the OFFIce What You Need to Know About Chronic Care Management in 2015 By Juli Koprowski, Practice Advocacy Specialist, Oregon Medical Association with the Advent Of 2015, CMS’ policy and reimbursement for Chronic Care Management, or CCM, became effective. Let’s take a look at some of the highlights of the CCM guidelines as CMS details in its Chronic Care Management Services MLN Fact Sheet (ICN 909188 January 2015).1 Œ The patient eligibility is detailed within the CPT definition of the code: Œ Patients must be informed of: CCM eligibility along with an explanation of what CCM services are, the cost sharing that applies, that only one practitioner can furnish and be paid by Medicare for CCM services within the service time period, and that the sharing of their relevant medical information will be shared electronically with other providers; ability to consent or decline to these services; including the right to discontinue CCM verbally or in writing at any time. Œ Providers must inform patients, who are eligible, of the availability of the CCM services and obtain written consent (or decline) prior to furnishing or billing for the service. CMS does not provide a form for this purpose. Some of the patient agreement provisions require documentation to occur within a certified EHR (Electronic Health Record); refer to table one within the CMS Fact Sheet for a complete listing.2 Œ CMS’ Chronic Care Management Fact Sheet, highlights, “The CCM service is extensive, including structured recording of patient health information, an electronic care plan addressing all health issues, access to care management services, managing care transitions, and coordinating and sharing patient information with practitioners and providers outside the practice. Some of the CCM Scope of Service elements require the use of certified EHR or other electronic technology.” Review the complete list of requirements that must be met in order to bill the CCM service; refer to table 1 within the CMS Fact Sheet.3 1,2,3. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicare Learning Network. “Chronic Care Management Services”, ICN 909188. Accessed: http://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ ChronicCareManagement.pdf Read the complete Fact Sheet for full details on all of the requirements: http://www.cms. gov/Outreach-and-Education/Medicare- Learning-Network-MLN/MLNProducts/ Downloads/ChronicCareManagement.pdf. 22 Medicine in Oregon www.TheOMA.org
OMA Spring 2015 Magazine
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