Medicare Made Hundreds of Thousands of Dollars in Overpayments for Chronic Care Management Services

Effective January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) established a policy for Medicare to pay under the Medicare Physician Fee Schedule (PFS) for chronic care management (CCM) services rendered to beneficiaries whose medical conditions meet certain criteria. Before that effective date, physicians did not have the ability to bill separately for typical non-face-to-face care management services provided to these beneficiaries. CCM payments are at a higher risk for overpayments compared with payments for more established Medicare services. CCM services are a relatively new category of Medicare-covered services and have multiple restrictions on when and how they can be billed.