Frequently Asked Questions

CCM 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, with a patient that has multiple (2+) chronic conditions expected to last at least 12 months or until the death of the patient. During that 20 minutes of time a comprehensive care plan must be established, implemented, revised and/or monitored.

Absolutely. We approach our patient engagement as an extension of your practice and patient care team.

Yes. The Center for Medicare and Medicaid Services (CMS) provided an exception under Medicare’s “incident to” rules specifically for chronic care management services. This permits clinical staff to provide the chronic care management 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).

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 chronic care management services, and to initiate the chronic care management service as part of this exam/visit.

Yes. NxCense Health uses a Meaningful Use Stage 2 certified EMR.

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.

Regardless of specialty, any Medicare-Credentialed Physicians, Advanced Practice Registered Nurses, Physician Assistants or Clinical Nurse Specialists are eligible to bill Medicare for chronic care management services.

At this time, other Non-Physician Practitioners and Limited License Practitioners (e.g., Clinical Psychologists, Social Workers) are not eligible.

No. CMS will pay only one claim for chronic care management services, per beneficiary, per calendar month.

Yes. There are four types of services that cannot overlap with chronic care management 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

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.

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