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Chronic Care Management: How to Achieve Billing Success


To bring down accounts receivable and achieving faster claims payment is among the priorities of every medical practice. Revenue cycle management, when handled with care and expertise, allows physicians to focus better on patient health care without having to put up long hours on medical billing and related activities.

Role of Chronic Care Management in the Health Care Industry

Medicare offers providers an opportunity to bill for certain services that they were managing for free in the past – this has been made possible by the Chronic Care Management program.

Involving a heavy amount of payment, Medicare’s Chronic Care Management program enables practices to create newer avenues while ensuring that clinical outcomes and experience of patients are considerably improved.

Significance of Chronic Care Management and Practice Profit

Chronic Care Management, the new revenue stream that provides opportunity for improving care and increasing reimbursement to health care facilities, is found to be one of the sources for maintaining financial stability of practices. This can be achieved through efficient work flow. Accurate coding and billing knowledge are crucial to accomplish success in this revenue stream.

Tips for Achieving Success through Chronic Care Management

  • Potential Revenue by taking part in this program
    • Physicians: Considering that all patients are covered by traditional reimbursement, providers may expect $ 45,000 to $ 180,000 through this stream
    • Practices: If half of their eligible patients have been enrolled in this program, there is potential for practices to generate more than $ 75,000 revenue per physician
  • Who is eligible to Bill for Chronic Care Management Service?
    • Primary care physicians, specialists, registered nurses, physicians’ assistants, and certified nurse midwives are eligible to bill for this program
  • Number of Practitioners who Can Bill for Chronic Care Management
    • CMS entertains payment for only one Chronic Care Management claim per calendar month per beneficiary
  • Medicare Patients Eligible for Chronic Care Management Services
    • Medicare patients having two or more chronic ailments which are expected to last for 12 months or till their death are eligible for this program – such diseases expose the patients to risk of acute exacerbation, death, or functional decline
  • Mutually Not Billable Services
    • When you have billed for Chronic Care Management service in a month, you cannot bill for four other services during the period – these are transitional care management, home health supervision, hospice care supervision, and certain end-stage renal diseases

Other Factors to Consider

Patient’s written consent is essential for billing for Chronic Care Management. Coinsurance and deductibles apply. In case other E & M or procedural services are offered, they may be billed appropriately.

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