How to choose a chronic care management company: 15 questions to ask

Questions to ask a chronic care management provider should begin with responsibilities: who performs the work, who directs it and what evidence supports your practice’s claim. Use the same sample patient and calendar month with every candidate so you can compare actual workflows.

In this guide, provider refers to the service organization you are evaluating. The billing practitioner retains required clinical involvement; an external team does not replace that responsibility.

Questions to ask a chronic care management provider first

Start with your own operating needs. Name the practitioner who will direct the service, the person who can answer clinical questions and the billing reviewer who will assess the monthly record. A partner demonstration is useful only when those people can see how the proposed work fits their responsibilities.

CMS permits clinical staff external to the practice when incident-to and other CCM billing rules are satisfied. It also warns that limited practitioner oversight or a lack of clinical integration with a third party can mean CCM was not furnished. Ask how the proposed arrangement maintains that connection in daily work.

The in-house versus outsourced CCM comparison helps decide whether an external arrangement fits before you shortlist candidates. A service team, software license and internal staffing plan solve different operational needs. Define the work you want help doing before comparing proposals.

• Bring the tasks your staff currently performs and the gaps you want to address.
• Bring the records your billing reviewer expects to receive and where they must be stored.
• Bring the practice roles that will approve outreach, answer clinical questions and review claims.

Do not share identifiable patient information just to obtain an introductory demonstration. A fictional example can test the workflow. Agree separately on any necessary data access and handling before the service begins.

Questions to ask a chronic care management provider: steps

1. Who confirms eligibility and the initiating visit?

CCM requires two or more chronic conditions expected to last at least 12 months or until death, with significant risk of death, acute exacerbation or decompensation, or functional decline. Ask who prepares the referral list and how the billing practitioner confirms the qualifying needs. A diagnosis list alone should not be treated as a completed clinical decision.

For new patients or patients the billing practitioner has not seen within the previous year, an initiating visit is required before CCM starts. A qualifying comprehensive face-to-face E/M visit, annual wellness visit or IPPE can serve, with CCM discussed by the billing practitioner. Ask to see how the visit and discussion are confirmed before enrollment proceeds.

2. Who explains consent and records the patient’s decision?

Ask for the actual consent explanation and the record it produces. CCM consent may be written or verbal, but it must be documented before billing. The patient must hear about availability, possible cost sharing, the one-practitioner monthly rule and the right to stop effective at month end.

Ask how a refusal or request to stop reaches your office. Consent is obtained once unless the patient changes billing practitioners; it is not a routine monthly or annual signature task. An initiating visit and consent remain separate requirements, even when handled during the same encounter.

3. Who can do the work, and who directs it?

Ask which people perform each task, who employs or contracts with them, and how qualifications and scope of practice are checked. Medicare permits employees and contracted clinical staff under the applicable incident-to rules. A job title or a software login does not determine whose time qualifies.

Clinical-staff CCM operates under general supervision, meaning the billing practitioner retains overall direction and control without needing to be physically present during the service. Ask how staff receive directions and return questions to the practitioner. The practitioner cannot delegate all required involvement to the service organization.

4. Where do the patient data and care plan live?

CMS requires structured recording of demographics, problems, medications and medication allergies using acceptable certified EHR technology. It also requires an electronic comprehensive care plan based on the patient’s assessment and available resources and supports. Ask which system holds each record and who keeps it current.

Request a demonstration of a plan update from the service team to your practitioner and back to the usable record. Verify how relevant team members obtain the information they need. Treat EHR integration as something to demonstrate for your environment, rather than assuming every product supports it.

5. How will access, continuity and clinical handoffs work?

CCM includes access 24 hours a day, 7 days a week to an appropriate care team member for urgent chronic care needs, continuity through a designated team member and enhanced communication opportunities. Ask who covers each function and how the practice connects with that coverage. Routine scheduled outreach is not the same as access for urgent needs.

Use a fictional change in the patient’s plan to test the handoff. Ask who receives it, who determines the clinical response and where the decision becomes visible. Also ask who performs that role when the usual contact is absent.

6. Can we trace the monthly time to qualifying work?

For 99490, the clinical-staff pathway requires at least 20 qualifying minutes per calendar month; 99439 represents each additional 20 minutes. Ask for a sample that identifies the person, activity and time behind the total. A summary number without the underlying work is not enough for your reviewer to understand the proposed claim.

Confirm how the workflow prevents time from being counted toward another billed service. Ask what happens when the documented service does not meet a code’s requirements. The appropriate answer is a review of the actual record, rather than a promise that every enrolled patient produces a monthly claim.

7. What does the practice billing team receive and approve?

Ask the candidate to show the package that reaches billing and distinguish it from the patient-facing notes. Your team needs a practical way to find consent, the current care plan, required initiating-visit evidence and the month’s activities. Agree on who resolves a missing item before the claim is submitted.

Keep code selection with the practice’s billing process. Check the actual practitioner and service month when considering other care-management services. A company’s program label should not substitute for that review.

8. What happens when the arrangement changes?

Ask about records access, readable exports, notice requirements and handover responsibilities before signing. These are contract questions, not promises that every company has the same terms. Have the relevant practice reviewers assess the proposed agreement and any unanswered responsibilities.

Use a mock transition to test who receives the current plan, outstanding follow-ups and existing consent record. If the billing practitioner changes, CCM consent must be obtained and documented by the new billing practitioner before the service. Do not assume changing service organizations always means the billing practitioner also changes.

A checklist for comparing the evidence

Step	Who does it	What CMS requires	Record kept
Eligibility and visit	Billing practitioner with practice support	Qualifying conditions and initiating visit when required	Clinical assessment and visit/discussion evidence
Consent	Named consent workflow owner	Documented written or verbal informed consent	Patient decision and explanation record
Staffing	Practice and proposed service team	Incident-to rules and general supervision	Responsibilities, personnel and handoff process
Patient information	Named record owners	Structured EHR data and electronic comprehensive plan	Current data and care plan
Access	Practice and assigned coverage team	Access, continuity and enhanced communication	Agreed coverage and communication workflow
Monthly service	Qualifying personnel and billing reviewer	Required service elements and qualifying time	Activities, people and time supporting the review
Claim approval	Practice billing team	Only report a service whose requirements are met	Reviewed monthly record and claim decision

Keep an answer column in your own comparison worksheet for each candidate. Mark a missing demonstration as unresolved rather than guessing that a polished presentation implies the function exists. You can distinguish a capability that is ready now from a proposed change or an item excluded from scope.

The CCM software evaluation guide gives a focused demonstration checklist for record access and activity tracking. Use it when the proposed service includes technology. A software feature and the team responsible for using it are separate questions.

Answers that should pause a proposed claim

A claim that the partner handles everything needs a specific follow-up: which functions still require the billing practitioner? A promise of automatic billable months needs the underlying service and records. A statement that every call counts needs a review of the personnel and the actual activity.

Do not treat those questions as a reason to prefer a particular brand. Apply the same standard to your own staff and every external candidate. Record the unanswered point and the person responsible for resolving it.

Turn the demonstration into an operating agreement

1. Choose one fictional patient and month for the final walkthrough.
2. Assign eligibility, consent, care-plan updates, handoffs and claim review to named roles.
3. Request the sample records and access demonstrations discussed above.
4. Record unresolved terms, exclusions and proposed changes separately.
5. Confirm that the practice team can explain the resulting workflow before launch.

The result should be a usable division of work. A staff member should know where a clinical question goes, a patient should know whom to contact, and a billing reviewer should know what supports the claim. Keep that operating description with the agreement so responsibilities do not depend on a sales conversation.

Discuss the responsibilities your practice wants help with

Review chronic care management services for practices when you are ready to compare an external team’s role. Bring the evidence requests and unresolved handoffs from your worksheet.

Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license. Which team members’ time counts toward each code is set in your services agreement.

Companian offers one dedicated Care Advocate, the same person every time. Confirm the proposed scope and how it connects with your practice’s clinical and billing decisions.

Key takeaways

• Start with practitioner responsibilities and a sample patient example.
• Ask to see consent, plan updates and the monthly service record.
• Verify staff qualifications, supervision and clinical handoffs.
• Demonstrate technology access instead of assuming integration.
• Put unresolved scope and transition terms in writing.

Frequently asked questions about questions to ask a chronic care management provider

Should a CCM partner demonstration use a real patient record?

A fictional patient can test the proposed process without supplying identifiable information. Agree separately on necessary data access before operational work begins.

Is verbal consent acceptable when evaluating a CCM enrollment process?

Yes, CCM consent may be written or verbal when documented with the required explanation. Ask to see the explanation and the resulting consent record.

Does a CCM service organization replace the billing practitioner’s oversight?

No, the billing practitioner must retain required involvement. External clinical staff arrangements must satisfy incident-to and other CCM rules.

What should we request besides a CCM software demonstration?

Request a sample consent record, care-plan handoff and traceable monthly service record. Also identify the people who operate the software and resolve clinical questions.

Can a CCM proposal assume every enrolled patient is billable each month?

Enrollment alone does not satisfy the service or time requirements. The practice should review the actual month before determining whether to bill.

Does switching a CCM service organization always require new patient consent?

CCM consent is obtained once unless the patient changes billing practitioners. Check who will bill and what the existing consent record supports during the transition.

Physician practices evaluating Medicare Part B chronic care management, including 99490 and 99439, should verify staffing and records while retaining required practitioner involvement. For Companian, your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Read more: In-house versus outsourced CCM · CCM software evaluation · CCM documentation

Disclosures

Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.