By HealthArc | March 16, 2024

Medicare Advantage (MA) is a third-party insurer required to provide the same coverage for healthcare services as original Medicare does. Chronic care management (CCM) is covered as part of Medicare Part B and is reimbursable under Medicare Advantage as long as a patient meets the eligibility requirements.

A Medicare Advantage plan is required to provide it’s enrolling patients with at least traditional Medicare coverage, including the CCM. This means an MA plan will reimburse or pay for CCM just like it does for other physician and healthcare services.

In this blog post, we’ll explore more about MA plans for CCM reimbursement.

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Medicare Advantage Is Similar To Medicare Part C

Medicare Advantage is also known as Medicare Part C, and used interchangeably referring to each other. It’s an alternative to getting Medicare Parts A, B, and D through a third party, where Medicare Part A covers inpatient stays and hospital visits, Medicare Part B covers outpatient services including doctor’s office visits, and Medicare Part D covers prescription medicines.

Medicare Advantage Coverage For Chronic Care Management (CCM)

Chronic care management is covered by Part B of Original Medicare (OM), which is add-on coverage to Medicare Part A. Patients who add this coverage will have to pay an extra monthly fee for Part B. If an individual opts for an MA plan, Part A and Part B coverage are automatically covered. Some Medicare Advantage plans cover the Part B premium, while others ask the insured to pay it in addition to their MA monthly premium.

The Centers for Medicare and Medicaid Services (CMS) pay a fixed monthly amount to the company providing an MA plan to an individual. This means individuals who choose an MA plan continue to receive the same financial compensation from Medicare as those having an Original Medicare.

Original Medicare (OM) and Medicare Advantage (MA) differ primarily in the entity providing health insurance coverage. In MA, a third-party insurance provider utilizes monthly Medicare payments to cover expenses, while OM directly administers coverage. Despite this distinction, MA plans are mandated to adhere to uniform regulations and provide comparable protection to Original Medicare.

If a patient is eligible for both Medicare and Medicaid, Medicaid will cover the premiums and coinsurance for chronic care management. When opting for dual insurances, individuals receiving CCM service will not be subject for cost sharing as this service will be covered by Medicaid.

HealthArc Is Proactively Making Chronic Care Management (CCM) Easier

In healthcare industry, complying with Medicare documentation and billing standards needs a lot of efficiency and efforts. HealthArc is a trusted digital health platform assisting physicians and healthcare professionals in delivering scalable care coordination and reimbursement solutions. Our platform delivers: