Open Forum

Good morning, and happy Saturday,

I work at a primary care clinic in Colorado and use Epic. Within the organization, there is confusion as to what payor type (insurance) can be used for Chronic Care Management (CCM) to get reimbursement. I have heard that the patient can only have medicare, but MUST have a secondary insurance, that can not be medicaid. Our patient population in our clinic is mainly medicaid (75-80%). Furthermore, if they do have medicare as their primary, they likely have medicaid as their secondary.

Can anyone please give guidance, as to which patients we can enroll in CCM so that we are getting reimbursement? I'm not sure where to find resources for this and the leaders of organization do not either.

Thank you so much for any guidance!

Sincerely,

Aspasia "Ace" Fowler, Lead RN
Pueblo, Colorado

Faith,

Thank you so much for the information and for sharing the spreadsheet. It is very helpful!  Do you know if there is a cost estimator that can be used to inform the patient of what they may be charged for the CCM per month? The percentages that you included are helpful! I just don't know how to put that into a monthly amount to the patient. I know it will depend on other factors that you listed.

It is fantastic that you are on the advocacy committee! I'm not too sure how our legislature would look at it, just because I haven never been involved in that portion.

Thank you!

Sincerely,
Aspasia "Ace" Fowler, RN

Original Message:
Sent: 01-26-2025 15:55
From: Faith Jones
Subject: CCM payor type

Hello, ok so as of February 2024, Colorado Medicaid does not cover CCM. Here is a spreadsheet of the Medicaids that I have researched. 

https://www.dropbox.com/scl/fi/l435yqz7p9jr85a8er1sj/Medicaid-Care-Coordination-Fee-Schedule-per-State_.xlsx?rlkey=bpm3gavhhtymh8kqf4guu47ry&st=bzex9lk7&dl=0

Now as far as Medicare, any patient on Medicare, including Medicare Advantage can have CCM. Must if the MA plans cover it at 100%. Traditional Medicare covers it at 80%. The other 20% is paid by the patient, if they are dual eligible, the 20%gets billed to Medicaid and it is covered by Medicaid so no out of pocket for the patient. Now being covered and being paid are not the same, the Medicaid EOB May tell you to write it off but good news nothing out of pocket for the patient. Now if the patient has a supplemental then the supplemental is required to pay the 20% once the deductible is covered. 

Hope that helps. Now I am also on the advocacy committee and I am happy to help you start conversations with your state legislators / Medicare medical director to have your CO Medicare cover CCM.