Care Coordination Documentation Template

Chronic care management services mln booklet icn mln909188 july 2019 the centers for medicare medicaid services cms recognizes chronic care management ccm as a critical component of primary care that contributes to better health and care for individuals.

Care coordination documentation template. Systematic assessment system based approaches medication reconciliation oversight of patient self management patient centered care plan manage care transitions coordination of care offer enhanced opportunities to communicate with the team. It is quite possible that there will not be a ccm code billed for every patient every month some months may not generate 20 minutes of care coordination. In 2015 medicare began paying separately under the medicare. Continue your attempts to communicate with the beneficiary until they are successful.

A template developed at the atlanta vamc standardizes and captures data about care coordination components in a patients electronic heath record. This template should copy over some elements of the care plan documented during the initial face to face visit including. Transitional care management tcm describes the oversight and coordination of healthcare services for patients transitioning from an inpatient hospital setting. The cpt codebook provides codes and guidelines to report tcm which allows providers to recoup payment for services they may already provide to their patients.

Transitional care management services mln fact sheet page 4 of 8 report the service if you make two or more unsuccessful separate attempts in a timely manner. 3 consider building a template in your emrehr that you or your clinical staff can use to document each ccm service. Insure the patient has continuity of care provide care management of chronic conditions. Section 412 implementcare coordination task plan and weekly schedule 3 suggested approach to planning and scheduling cc tasks 1 review the care coordinator job description general tasks to be performed identified above tips for effective time management and status of the ccc program as represented.

Documentation templates hicm care manager activity tracking worksheet a concise tool to track the care managers work with an individual patient and includes list of billing codes. If after hours care is provided by a clinician who is not part of the practice such as for call coverage. Document time spent doing different aspects of care and care coordination. Your attempts in the medical record if you meet all other tcm criteria.