You Don’t Have to be a PCP to Provide Chronic Care Management

As of 2012, close to half of all adults in the United States had one or more chronic health conditions, such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis. In 2014, heart disease and cancer accounted for 46% of all deaths.

Numerous studies have shown that using remote monitoring technology to provide Chronic Care Management (CCM) services significantly improves the quality of life for chronically ill patients. Not only do they not have to travel as much, which can be difficult for suffering patients, but the ability to check in with these patients remotely and more frequently reduces the risk of hospitalization and death. Patients with multiple chronic diseases require the closest care and attention, and CCM makes this process easier and more convenient for everyone.

A common misconception is that these patients’ primary care physicians should be the ones to provide Chronic Care Management, but that is not strictly the case. Chronic Care Management is just as, if not more, ideal for specialists, and can also be utilized by highly qualified non-physicians, such as nurse practitioners, clinical nurse specialists, and certified nurse midwives. Chronic Care Management can be the most effective way to be reimbursed for all the services these providers give to their most vulnerable and chronically suffering patients.


The vast majority of patients with chronic illnesses also see specialists to help manage their condition. According to CCM, many cardiologists provide Chronic Care Management for their patients with serious heart conditions. Likewise, urologists and other types of specialists see similar types of patients. One in four adults has two or more chronic conditions, which can be close to impossible for PCPs to manage. This number triples when it comes to the Medicare population. As overwhelming evidence continues to prove that CCM is ideal for chronically ill patients, we will see a rise in specialists who choose to provide Chronic Care Management services when the PCP does not.

Nurse Practitioners

Nurse practitioners are specially trained to provide health promotion through the diagnosis and treatment of chronic illnesses, which makes them perfect candidates to provide Chronic Care Management. The requirements that must be met for a nurse practitioner to be a CCM billing practitioner are similar to those that apply to physicians:

· Practitioners (or their staff) must have at least 20 minutes of patient interaction per month.

· Patients must be Medicare patients.

· The patient must have two or more chronic conditions.

· The patient must give written consent.

· The patient must pay a non-waivable monthly copay that is the patient’s responsibility

Clinical Nurse Specialists

Just as cardiologists and other specialists who are physicians can provide Chronic Care Management, clinical nurse specialists can bill their patients for services through CCM. Whether you work in pediatrics, gerontology, women’s health, or another specialty field, you can provide Chronic Care Management to your patients if they meet the criteria.

Certified Nurse Midwives

Certified nurse midwives are ideal candidates to provide Chronic Care Management. They provide care for women over the course of their lifetime, but pregnancy and the postpartum period can be intensely vulnerable times for women with multiple chronic conditions. Chronic Care Management gives these women a 24/7 approach to their care, which is not only convenient, but also incredibly comforting. Furthermore, it makes it possible for the certified nurse midwives to be reimbursed for every service they provide along the way, whether in-person or remotely.


Contributor: Haley Crigger is a currently studying for her Masters Degree in Creative Writing at Johns Hopkins University. She is a native of Union, Kentucky, and has been involved in programs such as Teach for America, a nonprofit organization focused on confronting educational inequity. Haley is a contributor for many publications, including iSalus Healthcare.