Myth or fact? Chronic care management consent is required regularly

Andis Robeznieks , Senior News Writer

There are some physicians who believe that the Centers for Medicare & Medicaid Services (CMS) requires them to obtain patient consent at regular intervals to continue to bill for ongoing chronic care management services.

So, is patient consent for chronic care management required regularly?

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It is a myth. The truth is that CMS does not require physicians, other health professionals or health care organizations to obtain patient consent for chronic care management that is done on a regular, recurring schedule.

The AMA is spreading this message as part of a series of “Debunking Regulatory Myths” articles that provide clarification to physicians and their care teams in an effort to reduce the administrative burdens that divert doctors’ attention from the delivery of patient care.

“Patient consent—verbal or written—is only necessary before the start of chronic care management services and if the patient changes to a new billing practitioner for these services,” the AMA explainer says. Reducing redundant or unnecessary tasks, such as obtaining consent when it’s not needed, can save practices time and increase efficiency.

In the latter scenario, the new physician or health professional is responsible for obtaining patient consent before providing chronic care management services themselves, the explainer adds.

It also notes that “whether patient consent to receive chronic care management services is obtained in a written or verbal manner, it must be documented in the electronic medical record.”

Chronic care management includes patient care coordination services such as care planning, care management, help with transitions of care and support with achieving health goals while prioritizing continuity of care.

These services are typically delivered outside of a regular face-to-face office visit and delivered by a care team led by a physician or other licensed independent practitioner.

Eligible patients have two or more chronic conditions expected to persist for at least 12 months or until their death and are at increased risk of acute exacerbation or decompensation, functional decline or death.

Doctors, physician assistants, clinical nurse specialists, nurse practitioners and certified nurse midwives may bill monthly for chronic care management services for as long as the services continue, the explainer says.

A CMS FAQ document cited as a resource for the explainer, lists elements that are typically included—but not strictly required—for purposes of billing CMS for chronic care management services. They are:

  • Problem list.
  • Expected outcome and prognosis.
  • Measurable treatment goals.
  • Cognitive and functional assessment.
  • Symptom management.
  • Planned interventions.
  • Medical management.
  • Environmental evaluation.
  • Caregiver assessment.
  • Interaction and coordination with outside resources, physicians or other health care professionals.

Learn more with the “AMA Debunking Medical Practice Regulatory Myths Learning Series,” which is available on AMA Ed Hub™ and provides regulatory clarification to physicians and their care teams. For each topic completed, a physician can receive CME for a maximum of 0.25 AMA PRA Category 1 Credit™.

Physicians are encouraged to submit questions or ideas they have about potential regulatory myths. The AMA’s experts will research the matter. If the concern turns out to be a bona fide regulation that unnecessarily burdens physicians and their teams, the AMA can advocate for regulatory change.