Practice Test Geeks(CCP) Chronic Care Professional Certification Practice Test
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CCM Billing & CMS Guidelines Flashcards

7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 CCM Billing & CMS Guidelines flashcards as text

  1. Before initiating CCM services, Medicare requires the provider to obtain patient consent. This consent must be:

    Answer: Written and retained in the medical record

    CMS requires written (or verbal with documentation) consent before billing CCM, and it must be retained in the medical record.

  2. A patient has two chronic conditions expected to last at least 12 months and places them at risk of acute exacerbation. This meets which core CCM eligibility criterion?

    Answer: Minimum chronic condition requirement

    CMS CCM eligibility requires at least two chronic conditions expected to last at least 12 months or until death that place the patient at significant risk.

  3. A CCM-enrolled patient is hospitalized for 5 days in the middle of the billing month. Can CCM still be billed for that month?

    Answer: Yes; inpatient days are excluded but outpatient CCM time may still meet threshold

    Inpatient time cannot be counted toward CCM minutes, but if sufficient qualifying outpatient/non-face-to-face time exists, CCM may still be billed for that month.

  4. Which Medicare beneficiary cost-sharing applies to CCM services billed under 99490?

    Answer: Standard Part B cost-sharing (typically 20% coinsurance after deductible)

    CCM is a Part B service subject to the standard 20% coinsurance after the deductible, unless the patient has supplemental coverage.

  5. CMS requires CCM patients to have 24/7 access to their care team. Which mechanism satisfies this requirement?

    Answer: An after-hours answering service that can access the patient's care plan

    24/7 access must include a way for the patient to reach a clinical staff member who can access their electronic care plan at any time.

  6. What is the minimum number of chronic conditions a Medicare patient must have to qualify for standard CCM billing?

    Answer: Two

    CMS requires at least two chronic conditions expected to last 12 months or until death to qualify for CCM under 99490 or 99491.

  7. If a patient revokes consent for CCM mid-month, the provider:

    Answer: May still bill for time spent before revocation that month

    CMS allows billing for CCM time legitimately performed before consent was revoked, as long as the minimum time threshold was met.