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Chronic care management: What physicians and compliance officers need to know

Rachael Price ( is Nurse Auditor with Strategic Management in Alexandria, VA.

In 2015, the Centers for Medicare & Medicaid Services (CMS) implemented chronic care management (CCM) services in an effort to reduce the cost of medical care for Medicare beneficiaries and to improve clinical outcomes for individuals with two or more chronic conditions. In 2017, CMS relaxed some of the regulations in terms of documentation requirements; these changes were meant to encourage providers to begin offering chronic care services. Physicians had been discouraged from providing CCM services because of the complicated billing rules. Despite the revisions made to CCM documentation requirements, billing for CCM services remains problematic. Thus the Department of Health and Human Services Office of Inspector General (OIG) is keeping a close eye on improper payments for CCM services. This article will focus on the documentation requirements for billing CCM services, how to avoid denials, and how to stay in compliance with CCM regulation and documentation requirements. Compliance officers may also consider this as a potential risk area and integrate it into their auditing and monitoring plans.

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