HCCIntelligence Recording: 2022 Coding & Policy Impacts-December 2021-Chronic Care Management Care Plan Requirements Resource

Chronic Care Management Care Plan Requirements Resource

Pdf Summary

This resource provides an overview of the required elements for the Chronic Care Management (CCM) Care Plan for home-based primary care (HBPC) providers. The resource highlights the various service elements and requirements for the CCM care plan, including structured recording of patient health information, maintaining a comprehensive electronic care plan, managing transitions and coordinating and sharing patient health information. The resource also discusses additional required service elements for CCM, such as documenting verbal consent, conducting initiating visits, providing 24/7 access to care, and establishing a relationship with a designated care team member. <br /><br />The document outlines the specific requirements for the care plan, including 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, periodic review, and revision of the care plan when applicable. <br /><br />The resource also emphasizes the importance of comprehensive care management, comprehensive electronic care plan, management of care transitions, home and community-based care coordination, and enhanced communication opportunities for CCM. <br /><br />Additionally, the document provides information on other resources available through the HCCIntelligence™ Resource Center to support HBPC providers and practice staff, including a hotline, webinars, virtual office hours, and downloadable tools, tip sheets, sample forms, and how-to guides. <br /><br />Overall, this resource serves as a guide for HBPC providers and practice staff in creating a standard CCM Care Plan, but it is not all-inclusive, and CMS guidelines should be referred to for full details and requirements.

Keywords

Chronic Care Management

Care Plan

Home-based Primary Care

HBPC Providers

Service Elements

Electronic Care Plan

Transitions

Patient Health Information

Verbal Consent

Comprehensive Care Management