What is Medicare’s Chronic Care Management Program?


The Centers for Medicare & Medicaid Services (CMS) recognizes that care management is one of the critical components contributing to individuals’ improved health, as well as reducing expenses. A Chronic Care Management (CCM) program may help avoid the need for more costly services in the future by proactively managing patient health and functional decline, rather than predominantly treating disease and illness.

CCM now allows 20 minutes per calendar month of non-face-to-face care coordination, directed by a physician or other qualified healthcare professional, for Medicare beneficiaries with two or more chronic conditions. Examples of chronic conditions include, arthritis, asthma, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and osteoporosis, among others.

Only one practitioner may be reimbursed by Medicare for the CCM service provided to a beneficiary during a given calendar month; there is no charge or co-pay to beneficiaries. A comprehensive care plan is established, implemented, revised, and monitored, and CMS expects the billing practitioner to coordinate with specialty practitioners to assist with care, as needed.

Shell Point residents benefit from an onsite medical center, staffed by fulltime physicians and ARNPs. For frequently asked questions about CCM programs, stay tuned for next week’s post.