Chronic Care Management History

How do I get to this page?

On the Quickview or Check-in page, click Update status/view history to the right of the Chronic Care Management field.

On the Checkout page, click the enrollment status under the Chronic Care Management field.

User access and permissions

To access this page, the Chronic Care Management program must be active for your practice. You can activate Chronic Care Management from the Care Program Configuration page. See Quick Reference — To make a care program active or inactive or Care Program Configuration for more details.

To update a patient's chronic care management status

You can update a patient's chronic care management status on the Quickview, Check-in, or Checkout page. You must manually update a patient's chronic care management status; athenaOne does not automatically determine this status.

On the Quickview and Check-in pages, the Chronic Care Management field appears under Insurances.
On the Checkout page, the Chronic Care Management field appears on the Patient tab under Miscellaneous.

Note: The Chronic Care Management field appears only if the patient has Medicare Part B or Medicare Advantage (Medicare Part B requires that patient consent be documented in the EHR). However, payers other than Medicare pay for CCM services.

To update the Chronic Care Management field:

On the Quickview or Check-in page, click Update status/view history to the right of the Chronic Care Management field (this field is in the Insurances section, under Eligibility).
On the Checkout page, click the enrollment status under the Chronic Care Management field.
The Chronic Care Management History page appears. This page allows you to modify a patient's CCM status and displays an audit history of all changes made to this field.
Click the Enrollment status menu and select a status: Not Enrolled, Enrolled, Enrolled Elsewhere, Declined, Unenrolled, or Ineligible.
If you select Enrolled from the menu, the Effective date and Expiration date fields appear. We recommend that you enter the effective and expiration dates, but these dates are not required.

Effective date — Enter the effective date for CCM enrollment (or click the calendar icon to select the date).
Expiration date — Enter the expiration date for CCM enrollment (or click the calendar icon to select the date).

Click Change Status.
The new status appears in the Enrollment status field, and the audit history is updated.
Click back to return to the Quickview, Check-in, or Checkout page.

Features and workflows

Chronic care management statuses

This table describes the enrollment statuses available on the Chronic Care Management History page.

Status	Description
Not Enrolled	Patient has never enrolled for chronic care management services.
Enrolled	Patient agreed to receive chronic care management services and provided written consent to the practice. Per CMS guidelines, The patient agrees to share the cost of chronic care management. The patient's designated provider is the sole CCM provider for the patient.
Enrolled Elsewhere	Patient informed the practice that he or she is enrolled for CCM services with a provider outside this practice.
Declined	Patient declined enrollment for CCM services.
Unenrolled	Patient elected to stop CCM services. Per CMS, the enrollment consent is valid through the end of the calendar month in which the patient unenrolls. Note: When a patient's Medicare insurance is cancelled or changed, the CCM enrollment status is automatically updated to Unenrolled. If the patient's Medicare insurance is subsequently reactivated, you must update the CCM enrollment status if the patient continues to receive CCM services.
Ineligible	Patient is part of another CMS/payer initiative that precludes separate reimbursement for chronic care management services.

Reports for chronic care management services

Two reports support chronic care management services. You can find these reports on the Other tab in the Report Library.

Chronic Care Management Eligible Patients — This report identifies all Medicare patients who may be eligible to receive chronic care management services. Eligible patients have two or more chronic conditions identified by the Department of Health and Human Services on historical claims. You can filter the report by Insurance Reporting Category to display patients potentially eligible for CCM by payer.
Medicare Chronic Care Management Claims Eligible to be Created — This report identifies Medicare patients who can be billed for chronic care management services.

Activate these reports using the Activate Reports page (On the Main Menu, click Settings > Implementation. In the left menu, under Practice Links — Reports, click Activate Reports).

To ensure that as many eligible Medicare patients as possible receive CCM services, athenahealth recommends that you automate report delivery on a monthly basis to the appropriate practice users.