Patient Eligibility

2015 has been a remarkable year in chronic disease management. Medicare introduced the Chronic Care Management program to facilitate the high-risk patient population which require constant provider contact. The primary goal of this program is to reduce the number hospitalization for these patients by keeping them engaged and informed about their treatment regimens and improving their overall health outcomes.

Eligible Patients for Chronic Care Management

Medicare defines eligible patients for chronic care management as:

  • A patient who is covered under Medicare Part B
  • Patient with multiple (2 or more)  chronic conditions
  • The chronic conditions are expected to last at least for 12 month or may be for life time
  • The chronic conditions can lead to further health complications
  • The chronic conditions have put patient at the risk of death or functional or physiological decline

Medicare defines chronic conditions as a health conditions that alters patients functional, behavioral, psychological and physiological activities.

The list of eligible chronic conditions can be very comprehensive, depending on the complexity and specialty of the billing practitioner. However, Medicare has published a broad-spectrum list of eligible chronic conditions such as: