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chronic care management program
Indications:
- >= chronic conditions expected to last >= 12 months or until death
- services that must be provided
- certified electronic medical record
- continuity of care with a designated care team member
- comprehensive care management & care planning
- transitional care management
- interaction & coordination with outside resources & practitioners & providers
- 24/7 access to address urgent needs
- enhanced communication (email)
- implementation may increase revenue for the work being done [1]
Notes:
- only 1 practioner can bill per month
- does NOT cover home visits
- Medicare part B will pay physician for home services on a fee for service basis for visits to homebound patients [1]
General
case management; chronic care management
References
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022