How to Qualify Your Patients for CCM Part 1

Let’s take a look at how you might go about managing your chronic care patients.  How do you add Chronic Care Management to your menu of services already underway in your practice?  You’re looking at the vast number of patients in your current practice, and wondering where to start.  How do you get this ship to float?  In this blog, let’s look at the single most important criteria for qualifying patients to begin with.


Medicare requires all of your qualifying patients under Chronic Care Management with Medicare to have two or more chronic conditions.  That is where the qualifying has to start.  Identify the patients that fall into this category.  These conditions have to be expected to last 12 months or until the death of the patient.  That is a simple factor in qualifying which patients you should be looking for as you start your program. That is your first earmark, it is the standard by which you decide, or judge, who actually qualifies.

When you look at this group of patients, your next thought might be how to start prioritizing them.  Which ones are in most need of a Chronic Care Management program?  After you have sifted through your practice to see who has the conditions that will meet the criteria for the code, then what?  That is the big question. Do you just sign them all up?  

Some doctors require that all of their patients be within the program. Many doctors think this to be the easiest and quickest approach. We have found that this is not the best approach.  

With Chronic Care Management, it’s important that your patients have buy-in.  You want them to see the advantages of being in a program like Chronic Care Management.  You want them to see the ways that Chronic Care Management can actually help.  You want them to identify this new level of care with the needs of their own personal health problems.

So now you have identified which patients qualify according to Medicare code.  Where do you go from here?  How do you prioritize your patients?  Where does that buy-in moment need to happen?  Let’s look at the first of five priorities, based on the highest risk first.


Those patients who are at highest risk are those who have been hospitalized recently or who make regular trips to the Emergency Room.  These patients definitely are a high priority.  Trips to the hospital or ER are a normal way of life for them.  Chronic Care Management defines their lifestyles! These folks definitely need to be on the program!

Your next step would be to go over the Chronic Care Management program with them.  This is where they see the opportunity and benefit for them.  We have available resources you can utilize in order to gain a better understanding of the program. You can get the pamphlet HERE

Now you have taken those at highest risk, those that are in the hospital or the ER, and you have defined and created your first subset of patients as you start your program.  Our next blog installment will map out three other subsets of patients that could benefit from Chronic Care Management.

Like what you read? If you're looking for help implementing Chronic Care Management at your practice, reach out to our team of experts!   

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