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Chronic Care Management: Know the Rules when Billing for this New Medicare Service

Chronic Care Management: Know the Rules when Billing for this New Medicare Service

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 Speaker:  Betsy Nicoletti, MS, CPC

Length 60-minutes


Betsy Nicoletti will teach you how Medicare beneficiaries with two or more significant chronic problems are eligible for this new service.

Some groups are already experiencing denials. Hear why and what you can do to prevent denials.

Medicare will pay primary care physicians a monthly fee for any month that twenty minutes of non-face-to-face time is documented. The practice must be using a certified EHR. This continues CMS’s stated goal of supporting primary care and recognizing the work done to manage patients before and after an office visit or other services. It follows payment for care plan oversight and transitional care management.

But, providing and documenting the service performed by the physician or staff is a little tricky. Before starting the service and billing for it, there are important steps to be taken. Informed consent must be provided for the patient and a written agreement signed. An electronic care plan must be developed, and the patient and team members need access to this electronic document. CMS has decided to use a CPT code, not HCPCS codes for this service. Only certain patients are eligible for the service, not all Medicare patients. And, the service may only be billed in a month when twenty minutes of service is provided. It’s not a per-member-per-month benefit to manage complex patients.

Listen to this 60-minute recorded webinar in which you’ll learn:

  • What patients are eligible.
  • How to sign up eligible patients.
  • The required components of the new chronic care management codes.
  • What needs to be documented.
  • What staff members may provide the service.
  • The EHR requirements.
  • The type of access a patient must have to the practice.
  • The allowance to incident to rules for this service.
  • What you have to do to collect the $40 fee.
  • Why it all starts with a face-to-face service with the patient, before you begin reporting chronic care management.

Meet Our Expert Speaker:

Betsy Nicoletti, is the co-founder of, devoted to physician reimbursement. She is also the author of The Field Guide to Physician Coding 3rd Edition and the Auditing Physician Services. She developed The Accurate Coding System™ to help doctors get paid for the work they do. As a certified coder, Betsy simplifies complex coding rules for practitioners and engages physicians in a positive and respectful way, which encourages attention and accuracy in their coding. Besides doing auditing and compliance work, she is a speaker, writer and consultant in coding education, billing and accounts receivable management