CCM and the Medicare Deductible
CCM and the Medicare Deductible Blog Feature
Daniel Godla

By: Daniel Godla on January 29th, 2018

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CCM and the Medicare Deductible

Medicare | Chronic Care Management

Note:  This article was originally written in January of 2018. 
It has been updated on January 3, 2019 for the new 2019 Medicare Deductible.


 With the start of a new year, practices are ramping up their CCM programs.  Patients are still working towards their "New Years Resolutions" of being healthier.  Plus, with an increase of "sick visits" during these winter months, it's the perfect time to promote Annual Wellness Visits and Chronic Care Management (CCM).

While AWVs are 100% free to the patient and do NOT count towards the patient's Medicare Deductible, CCMs are different.

With the average CCM reimbursement being around $42, the patient is usually aware that if they don't have any supplemental insurance, their worse case scenario might be an $8 to $9 copay.

However, in January... please keep in mind that the CCM DOES COUNT towards the patient's Medicare Deductible (if they haven't met it yet).  With the 2019 Medicare deductible at $185, it's certainly possible that your patients might not have met their deductible by the time you submit your January CCM claims.  This could result in the patient getting a $42 charge for CCM.  The last thing we want is for your patients to get "sticker shock" and cancel CCM.

Here are some tips to help:

  • Many of our practices choose to hold their January CCM claims instead of submitting immediately.  This allows for the patient to receive other services that will fill out the deductible.
  • If the patient notices a charge and sees $42 for CCM, explain to them how the medicare deductible works.  Explain to the patient that Medicare makes all patients cover the first $185 of their Medical services.  CCM just happens to be one of their first services of the new year.  If they weren't enrolled in CCM, it would be applied to another service.  They would be paying it one way or the other.
  • If a patient wants to cancel CCM because of the unexpected charge, explain that this service is highly recommended by their provider.  Because CCM counts towards their deductible, other services may now have little or no cost.  In a short period of time, the only charge may be a small copay.  That's a small price to pay for a dedicated care team, comprehensive care plan, and taking the steps to keep your chronic conditions well-managed.
 

About Daniel Godla

Dan is the Founder and CEO of ThoroughCare

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