CCP CCM Billing & CMS Guidelines 3

Question 1

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

Accepted Answer

Written and retained in the medical record

Answer

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

Question 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?

Accepted Answer

Minimum chronic condition requirement

Answer

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.

Question 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?

Accepted Answer

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

Answer

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.

Question 4

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

Accepted Answer

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

Answer

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

Question 5

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

Accepted Answer

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

Answer

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.

(CCP) Chronic Care Professional Certification Practice Test

(CCP) Chronic Care Professional Certification Practice Test

CCP CCM Billing & CMS Guidelines 3