Conditions That Qualify for Chronic Care Management
Chronic Care Management is a program that teaches Medicare patients more about their chronic conditions and how they can handle them. Via CCM, a patient is assigned a care coordinator who contacts him or her at least once a month to assist in setting up health objectives, arrange an appointment with a provider, remind the patient about the necessity to refill a prescription, and inform about available resources. However because some practices have never enrolled in Chronic Care Management, they may not be well informed with all the conditions that make the patient eligible for the program.
You will find the list of chronic conditions below to identify whether you are serving patients eligible for CCM and more information about CCM and how it can benefit those patients and give them tools to manage their conditions more effectively.
Eligible chronic conditions for CCM
For patients to be eligible for a Chronic Care Management (CCM) program under Medicare they need to have at least two conditions that are expected to last for at least twelve months and that they pose a risk of becoming worse or result in a decline in the patient’s functioning.
Below we provide you with a list of some of the most frequent qualifying conditions that we come across with patients: While these are conditions that would make a patient eligible for CCM, it is the provider who decides clinically that a patient requires CCM.
Blood and Cardiovascular Conditions
Patients with the following cardiovascular problems are eligible for CCM, however, these are not the only ones:
- Hypertension
- Ischemic heart disease
- Congestive heart failure
- Anemia
- Atrial fibrillation
- Hyperlipidemia
- Diabetes
- Coronary artery disease
- Sick sinus syndrome
- Angina
- Sickle-cell disease
- Peripheral vascular disease (PVD)
Oncology and Cancer Conditions
Various chronic cancer types qualify for CCM which include:
- Breast cancer
- Lung cancer
- Prostate cancer
- Colorectal cancer
- Leukemias and lymphomas
Bone, Joint or Muscle Conditions
Bone, joint, and muscle conditions that affect a person’s quality of life can qualify for CCM. Examples are:
- Osteoporosis
- Rheumatoid arthritis/osteoarthritis
Eye Conditions
Additionally eligible for CCM are conditions that impact a person’s vision, such as:
- Cataracts
- Glaucoma
- Diabetic retinopathy
- Age-related macular degeneration
Additional Chronic Conditions that Qualify for CCM
Some other conditions affect different body parts and qualify for the CCM:
Nephrology and Urology Conditions
Conditions that affect the bladder and kidneys include:
- Chronic kidney disease
- Benign prostatic hyperplasia
- Kidney cysts
Neurological and Mental Health Conditions
Neurological and mental health issues cover a wide range of illnesses, including:
- ADHD
- Alzheimer’s Disease and dementia
- Post-traumatic stress disorder (PTSD)
- Anxiety disorders
- Depressive disorders
- Autism
- Schizophrenia and other psychotic disorders
- Bipolar disorder
- Traumatic brain injury and nonpsychotic mental disorders due to brain damage
- Migraine and chronic headaches
- Cerebral palsy
- Epilepsy
- Parkinson’s
Gastroenterological Conditions
Some of the gastroenterological conditions that qualify for CCM are:
- Irritable bowel syndrome
- Crohn’s disease
- Ulcerative colitis
Ear, Nose, and Throat Conditions
A variety of ENT conditions can benefit from CCM:
- Sleep apnea
- Tinnitus
- Vertigo
- Conductive or sensorineural hearing loss
Respiratory Conditions
Medicare patients might face the following lung or respiratory conditions:
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Cystic fibrosis
Substance Use Disorders
Getting dependent on a substance makes a person have a substance use disorder. Those that can potentially qualify for CCM include:
- Alcohol dependence disorders
- Opioid dependence disorders
- Nicotine dependence
- Other drug use disorders
Autoimmune Conditions
Any other physical condition that affects a person’s immunity and recovery from an injury or disease can attract the CCM program. These conditions include:
- Human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS)
- Viral hepatitis
- Multiple sclerosis
- Hypothyroidism
Bone, Joint, Spine or Muscle Conditions
These conditions affect the nervous system or bones, muscles, and joints. Examples are:
- Spinal cord injury
- Spina bifida
- Muscular dystrophy
- Fibromyalgia
- Chronic pain
Other Disabling Conditions
Other conditions are disabling and might affect major life activities, so they could be eligible for CCM. These conditions include:
- Developmental and learning disabilities
- Intellectual disabilities and related conditions
- Liver disease, cirrhosis, and other liver conditions
- Blindness and visual impairment
- Meniere’s disease and other sources of hearing loss
- Obesity
What to Expect when Patients Qualify for CCM
When a patient is qualified to receive CCM, they will be informed about the program, and if they agree they will be enrolled. If they decide to do so, they will be provided with at least 20 minutes of care coordination with a care manager every month, through the general supervision of a qualified provider. These 20 minutes are not face-to-face, but if there is a need for an in-office meeting about CCM services, then there is. The patient will also have direct access to a care team member at any one time in case of an emergent medical event.
The care coordinator will assist them in developing a detailed care plan that the patient can access at any one time.e. The care coordinator will also be contacting the patient monthly to check in on the care plans, care gaps, appointment setting, or prescription refills.
Gen By Gen Health’s turn-key CCM/RPM solutions ensure compliance and health literacy – improving patient satisfaction and outcomes, increasing revenue, and decreasing staff workload.
To get in touch call us right now at (713)715-7997 to learn more about our CCM services or you can also book a 30 min free consultation.
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