The US government has been a stern supporter of chronic disease management programs. On the same side, it scrutinizes medical billing in chronic disease management. Suppose you are a provider offering chronic disease management services. In that case, it is essential that you appropriately follow the rules when it comes to medical billing services for chronic care management. Furthermore, you can expect more audits to investigate the core causes of overpayments, which are associated with incorrect billing of the services.
Medical billing process for chronic care management involves many vital steps including:
Below is an overview of how the process normally works:
A care team conducts consistent follow-ups and check-ins with patients, either through telehealth services or in-person, for better access:
Now that you have some idea about medical billing in chronic disease, let’s understand CCM a bit further. Chronic care management entails proactive and continuing care offered to patients suffering from chronic illnesses, including but not limited to heart diseases, diabetes, and COPD.
Chronic conditions mostly call for:
Chronic care management optimizes patient care by forming an out-and-out care team, encouraging patient engagement, and leveraging technology for efficient data management and communication.
Patients with two or more chronic conditions can qualify for reimbursable care under the relevant CPT codes. To qualify for CCM, the patients must be a risk of:
Furthermore, their conditions are expected to last at least 12 months or until death.
The core benefits of CCM and medical billing in chronic disease management offer the following benefits:
Often, patients suffering from chronic diseases present with gaps in their care. Reasons include:
For preventing such gaps in treatment, chronic care management programs help avoid gaps in patient care. The CCM program ensures that someone from the patient care team touches base with patients at least once a month. It is done to ensure that patients are on track to receive the best health outcomes possible.
The billing codes for CCM include the following CPT codes:
Ongoing treatment for chronic diseases can be coded for reporting as often as the patient receives treatment for their condition(s).
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