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Care Management - Payer Information

THN offers chronic care management or CCM for patients with 2 or more qualifying chronic conditions.

For each patient who receives CCM services, a THN clinician performs appropriate assessments and develops a comprehensive care plan. The plan will be maintained to address health issues, including medical and psychosocial issues, with a particular focus on the patient’s chronic conditions.

Our health care providers offer patients convenient and coordinated support. They engage and educate patients, review and revise care plans, personalize care for each individual, and coordinate care and facilitate referrals, including to helpful community services.

In addition, as part of our unique embedded care coordination model, THN health care professionals work together onsite with a growing number of practices.

Chronic Conditions

Chronic care management or CCM services are available to patients with 2 or more chronic conditions, which include but are not limited to:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial Fibrillation
  • Cancer
  • Cardiovascular disease
  • Chronic obstructive pulmonary disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS
  • Substance use disorders

Patient Participation Requirements

Chronic care management or CCM patients are provided with advance consent to ensure they are involved with their treatment plan and aware of any applicable cost sharing. Informed consent is given verbally, documented in the electronic medical record and provided to the patient as part of an after-visit summary.

As part of THN-provided coordinated care, patients agree to have 1 participating health care provider such as a primary care physician, and 1 hospital for any necessary services. Patients can request to opt out of chronic care management services at any time.

Payment Guidelines for CCM Services

In 2015, the Centers for Medicare & Medicaid Services (CMS) began paying for chronic care management or CCM services or Medicare patients with multiple chronic conditions. CMS provides a list of Medicare billing codes to pay for CCM services.

In addition, CCS provides the following additional resources: