APCM/CCM

Advanced Primary Care Management & Chronic Condition Management Consent

Medicare has two programs that cover additional services for beneficiaries like you, including:

24/7 access to your primary care team, to assist with urgent issues after hours
Primary care that is available in alternative ways to traditional office visits, including in-home visits
Transition management, including follow-up support from your primary care team after discharges from hospitals, skilled nursing facilities or other health care facilities
Comprehensive care plans, including a systematic needs assessment, regular updates as your clinical needs change, and support to ensure you receive preventive services
Care coordination support with specialists, community-based social services, home health, hospice, hospitals and other care providers that you may need from time-to-time
Electronic tools that let you (or your family) securely message your Pine Park care team, whether for a quick question, a medication refill, or help with care coordination
Systematic clinical quality programs to manage and adjust medications, ensure appropriate preventative screenings and services are completed, etc.
Use of a certified electronic health record (EHR)

These two programs are called "Advanced Primary Care Management" (APCM) and "Chronic Care Management" (CCM). The programs work in similar ways, with some variations depending on whether you have one or more chronic conditions. A chronic condition, as defined by Medicare, is expected to last for at least 12 months and increases the risk of functional decline or acute disease exacerbation. Examples of chronic conditions include arthritis, asthma, anxiety, glaucoma, cataracts, diabetes, high blood pressure, dementia, heart disease, depression, osteoporosis, and many others. As a Pine Park primary care patient, Pine Park Health will enroll you in our CCM and APCM programs.

For more information about CCM or APCM, please call 1-800-MEDICARE or visit: https://www.medicare.gov/coverage/chronic-care-management-services.

Medicare and all Medicare Advantage plans cover these CCM and APCM services, and most Medicare Supplemental (aka "Medigap") plans do as well. Per Medicare service guidelines, Pine Park will only bill Medicare or your Medicare Advantage plan once per calendar month for either CCM or APCM services, if you qualify for the program, based on your chronic conditions and whether you received 20 or more minutes of CCM services from your care team in that month.

‍ Acknowledgment

You consent to receive CCM & APCM Services if your primary care provider determines that you qualify.
You understand that only one provider (e.g. Pine Park Health) can offer and be compensated for CCM or APCM Services in a calendar month. Please let us know if you are enrolled in CCM or APCM with a different practitioner.
You acknowledge that we will bill either CCM or APCM in each month (not both), and will only bill for CCM services if a minimum of 20 minutes of care has been provided in the calendar month. Depending on your health plan(s), there might be cost-sharing obligations with Medicare for CCM or APCM Services. You may pay a monthly co-pay/fee, if you have a Medicare Advantage plan, and the Part B deductible and coinsurance apply if you have traditional Medicare. If you have supplemental insurance, including Medicaid, it may help cover the monthly fee. Some supplemental plans, including TRICARE, do not cover CCM or APCM, and you will be responsible for the Part B deductible or co-insurance if not covered by your supplemental insurance. If you have questions about patient responsibility, please contact your insurer or Medicare by calling the phone number on the back of your insurance card, visiting https://www.medicare.gov, or calling 1-800-MEDICARE.
You retain the right to cease receiving CCM or APCM Services at any time by canceling this agreement, effective at the close of the calendar month. Opting out can be done by phone at 510-929-1400 or in writing to Pine Park Health, 1901 4th Street, Suite 201, Berkeley, CA 94710. Pine Park Health will confirm the cessation via email, including the effective date.