CCM Sign-up

I agree that that this service is regarded by Medicare as an evaluation and management service and is subject to the same claim processing and payment standards as an office visit.
I agree that this service does not replace any of my regular appointments and is in fact designed to work in close correlation to enhance the care given.
I agree that all pertinent medical information will be shared on an “as needed” basis with other medical providers involved in my care and that only one provider may provide this service for me.
I understand that I am responsible for the monthly co-pay for this program, or full payment until my Medicare deductible is met. If I have secondary insurance, they may cover the no co-pay or out of pocket expense.
I understand that I may terminate this program at any time by informing my provider or care administrator that I am revoking my consent. I understand that I am encouraged to first discuss this with my provider should I decide to end my participation in this program.

About Chronic Care Management Program

Medicare regards the chronic care management program as a monthly, non-face to face evaluation and management service. It is covered just like an office visit. Medicare pays 80% of the monthly cost, which is usually $42. Most secondary insurances pay the remaining 20%. If the secondary insurance does not cover the cost, the fee is less than $10 per month, after your deductible is met. The usual annual Medicare deductible will be applied to this service. You will see a charge on your explanation of benefits (EOB) if this service was performed. Your fee is billed monthly and can be cancelled at any time, without penalty. This service is established and billed by your physician. Some of the program is administered by Cariatrix, Inc., in partnership with your physician’s practice.

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Terms Of The Program

By entering my personal information below I hereby consent to the terms of the program.