Billing for Chronic Care in Geriatrics: Common Pitfalls & Fixes

Billing for Chronic Care in Geriatrics: Common Pitfalls & Fixes

Chronic care management (CCM) is one of the most essential services provided to older adults in the U.S. As the geriatric population grows and chronic conditions become more prevalent, proper billing for chronic care services has become crucial for both reimbursement and care continuity. Yet many healthcare practices still struggle with the complexity of billing, coding, and documentation requirements associated with Medicare and other payers.
In this blog, we’ll walk through what chronic care billing entails, highlight the most common errors, and offer practical solutions that not only improve accuracy but also protect your revenue. We’ll also explore how tools like MaxRemind help geriatric practices streamline the process using advanced AI features.

What is Chronic Care Management (CCM)?

Chronic care management refers to the non-face-to-face services provided to Medicare beneficiaries who have two or more serious chronic conditions. These conditions are expected to last at least 12 months or until the patient’s death and place the patient at significant risk of functional decline or death.

CCM services are designed to support better long-term health outcomes. These services may include medication management, care coordination, appointment scheduling, and regular communication between patients and their care teams.

Medicare reimburses for CCM under specific guidelines, but only when services meet time, documentation, and eligibility criteria. Accurate billing ensures that the provider receives payment and the patient receives uninterrupted, high-quality care.
What is Chronic Care Management (CCM)-

E/M Coding in Emergency Medicine

Despite the opportunity for improved care and reimbursement, chronic care billing is full of potential errors that can result in denials or audits. Below are some of the most frequent issues.
Incomplete Time Tracking

CCM billing relies heavily on time-based documentation. CPT codes like 99490 require at least 20 minutes of non-face-to-face care coordination during a calendar month. Missing or inaccurate time logs can lead to denied claims or recoupments during audits. It’s essential to document not only the total time spent but also the nature of the interactions.

Using Incorrect CPT Codes

The codes for CCM services can be confusing. Practices may mistakenly bill 99490 when the time or complexity level qualifies for 99491 or even 99487. Each CPT code has different requirements related to time, clinical staff involvement, and complexity. Using the wrong code means underbilling or triggering rejections.

Missing or Inadequate Care Plans

To be eligible for CCM billing, Medicare requires that each patient have a comprehensive, regularly updated care plan. If the care plan is incomplete or missing entirely, your claim will likely be denied, even if services were provided. Care plans must include problem lists, expected outcomes, and measurable treatment goals.

Failure to Verify Eligibility

Medicare only pays for CCM services for patients with two or more chronic conditions, but it’s not enough to assume eligibility. Billing teams must verify that patients meet criteria and that no other provider has already billed CCM services during the same period. Neglecting this step can result in claim conflicts and non-payment.

Not Documenting Non-Face-to-Face Care

Providers often forget to record phone calls, portal messages, or coordination efforts with specialists, yet these non-face-to-face activities are precisely what CCM codes are designed to reimburse. If they aren’t documented, the practice loses revenue and may miss the opportunity to show the full scope of care being delivered.

READ HERE: 7 Revenue Cycle Management Mistakes

Solutions & Fixes for Common Errors

Many of these issues can be resolved with a few systematic changes to your workflow and documentation process.
  • Train Staff on Code Use: Ensure both clinical and billing teams understand when to use 99490 vs. 99491, and how to track qualifying minutes precisely.
  • Standardize Care Plans: Use electronic templates that auto-populate key fields. This reduces errors and ensures compliance with Medicare requirements.
  • Integrate Eligibility Checks: Add a verification step before billing to confirm that the patient qualifies and isn’t already under a CCM plan from another provider.
  • Automate Time Logging: Implement software that automatically records the time spent on calls, portal messages, and various interactions to minimize manual errors and ensure precise tracking.
  • Conduct Monthly Coding Audits: Conducting a regular review of claims before submission helps identify and correct minor issues early, preventing potential complications such as denials or audits down the line.
Solutions & Fixes for Common Errors

Leveraging Technology & AI in Chronic Care Billing

Advanced billing platforms are now integrating AI-powered solutions to assist geriatric practices in handling the complexity of chronic care billing. These systems automate the most error-prone parts of the process and reduce the manual burden on staff.
Here’s how AI tools are transforming CCM billing:
  • Smart Time Tracking: Automatically logs and calculates billable minutes based on provider activity
  • Code Validation Engines: Suggests the most accurate CPT code based on patient data and service details
  • Pre-Submission Compliance Checks: Flags missing documentation, eligibility issues, or unsupported codes before a claim is submitted
  • Denial Prediction Models: Use past data to predict which claims are most likely to be rejected and recommend changes.
Leveraging Technology & AI in Chronic Care Billing
MaxRemind is leading the way in this space by offering AI-driven billing software that simplifies CCM workflows for geriatric providers. With integrated charting, automated time tracking, and Medicare-compliant templates, MaxRemind helps reduce errors, save time, and increase reimbursement rates.

READ MORE: The Impact of AI in Medical Billing

The Benefits of Getting CCM Billing Right

Accurate chronic care billing doesn’t just protect your revenue—it enhances your ability to deliver consistent, quality care to your aging patient population.
  • Improved Revenue Stream: Accurate billing and fewer denials mean more predictable income
  • Better Patient Engagement: Ongoing communication and coordination improve patient outcomes
  • Reduced Staff Burnout: Automation and streamlined workflows free your team to focus on care
  • Lower Compliance Risk: Detailed documentation and code accuracy reduce audit risk
Take a free Geriatric Practice Audit
The Benefits of Getting CCM Billing Right

Conclusion

As chronic disease rates rise among seniors, providing consistent, well-coordinated care is more important than ever. But to do this effectively, geriatric practices must ensure their billing systems are accurate, compliant, and efficient.
Common pitfalls like missed time logs, coding errors, or incomplete documentation can cost your practice thousands of dollars and disrupt patient care. Thankfully, the right mix of training, workflow improvements, and AI-powered tools can transform your billing process.

Want to simplify your chronic care billing while improving revenue and compliance?

Explore MaxRemind’s AI-powered billing platform for geriatrics today.

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FAQs
What are the CPT codes for chronic care billing?

The most common CPT codes for CCM include 99490 (20 minutes of non-face-to-face care), 99491 (30 minutes of physician-provided care), and 99487/99489 for complex cases.

How can I avoid billing errors in chronic care management?

Use AI-powered billing software that automates time tracking, validates documentation, and flags compliance issues before submission.

Does Medicare cover chronic care management?

Yes, Medicare covers CCM services for patients with two or more chronic conditions expected to last at least 12 months and place the patient at risk of death or functional decline.

Can AI help with geriatric billing?

Absolutely. AI tools can suggest accurate CPT codes, predict denials, automate time logs, and improve billing accuracy for geriatrics and chronic care.

What is the best software for CCM billing in the US?

Solutions like MaxRemind offer integrated AI tools, Medicare compliance features, and automated claims handling specifically for CCM and geriatric billing.