Chronic Care Management (CCM) Care Plan Requirements - HCCIntelligence™ Premier Resource - 2024-Chronic Care Management (CCM) Plan Requirements

Chronic Care Management (CCM) Plan Requirements

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This document provides an overview of the required elements for the Chronic Care Management (CCM) Care Plan for home-based primary care (HBPC) providers and practice staff. It emphasizes the importance of structured recording of patient health information using certified Electronic Health Record (EHR) technology and the management and sharing of patient health information. The document also highlights the changes made to the requirements of the CCM care plan as a result of the 2024 Medicare Physician Fee Schedule final rule.<br /><br />The required elements for the CCM care plan include a problem list, expected outcome and prognosis, measurable treatment goals, cognitive and functional assessment, symptom management, planned interventions, medical management, environmental evaluation, caregiver assessment, interaction and coordination with outside resources and practitioners and providers, periodic review, and revision of the care plan when applicable. Other important aspects of the CCM service include 24/7 access to care, relationship with a designated care team member, comprehensive care management, timely availability of the care plan, management of care transitions and referrals, home and community-based care coordination, and enhanced communication opportunities.<br /><br />The document also provides information on the available CCM CPT codes for billing purposes and the new code created for additional provider-delivered CCM services. It also directs readers to the HCCIntelligence Resource Center for free and premium resources, including webinars, tools, tip sheets, and how-to guides related to home-based primary care. Additionally, contact information for the HCCIntelligence hotline is provided for further assistance.<br /><br />Overall, this document serves as a valuable resource for HBPC providers and practice staff, providing guidance on the required elements for the CCM care plan and relevant billing codes, as well as access to additional educational resources.

Keywords

Chronic Care Management

Care Plan

Home-Based Primary Care

EHR Technology

Medicare Physician Fee Schedule

CCM Requirements

Symptom Management

Comprehensive Care Management

CCM CPT Codes

Educational Resources