Medigy: Patient Eligibility for CCM

Chronic Care Management (CCM) is a Medicare program that provides additional care coordination and management services for patients with multiple chronic conditions. In order to be eligible for CCM, a patient must meet certain criteria set by the Centers for Medicare and Medicaid Services (CMS).

The patient must have at least two chronic conditions that are expected to last at least 12 months, or until the end of the patient’s life, and that place the patient at significant risk of death, acute exacerbation/complications, or functional decline.

Patients must also be seen by a primary care physician or practitioner at least once in the past 12 months and have an estimated annual healthcare expenditure of at least $2,500.

Additionally, the patient must be willing to participate in CCM and to have regular communication with their primary care physician or practitioner about their care.

Patients who meet these criteria can participate in CCM, which can include services such as care coordination, care planning, and medication management. By providing these additional services, CCM aims to improve patients’ health outcomes, reduce hospital readmissions, and lower overall healthcare costs.