Chronic Care Management (CCM) | Transitional Care Management (TCM) | Remote Patient Monitoring (RPM)

I agree to participate in all provided programs listed about;

Medicare/Medicaid/other contracted payers are offering a new benefit for beneficiaries with multiple chronic conditions and transition to the community setting following discharge from health care facilities as inpatient conditions. By consenting to this agreement, you allow Priority Medical Group to provide chronic and transitional care management and remote patient monitoring services to you.

Chronic Care Management (CCM) services are only available to patients with two or more chronic conditions. Medicare/other contracted payers define a chronic condition as a condition that is expected to last for at least 12 months, and that increases the risk of death, acute exacerbation of disease, or a decline in function.

Transitional Care Management (TCM) services are only available to patients who were recently discharged from an inpatient setting. On this service, health care professionals accept and take responsibility to care for the beneficiary post-discharge from the facility to community setting without any gap and continue care for the next 29 days, to prevent readmission.

Remote Patient Monitoring (RPM) is defined as a subcategory of homecare telehealth that allows patients to use mobile medical devices and technology to gather patient-generated health data and send it to healthcare professionals. Multiple patient conditions can be reported to your doctor to prevent hospitalization and/or coming into the office for visit because they can be done by telemedicine as a video virtual office visit.

Benefits of CCM, TCM, and RPM services include:

  • 24/7 access to health care management.

  • Quick and effective follow-ups after discharge from hospital, referrals, skilled nursing facilities, rehabilitation or other healthcare services.

  • Medication oversight and management.

Should a patient desire to receive CCM, TCM and/or RPM services through our providers at Priority Medical Group he/she agrees to only bill Medicare or contracted payers with reimbursement for CCM and TCM services once per 30 day billing cycle. Furthermore, they’re provider agrees to only bill Medicare or contracted payers with reimbursement for CCM and TCM services if recently discharged from an inpatient setting.

Beneficiary Acknowledgment and Agreement

By signing this agreement, you agree to the following terms:
  • You consent for Priority Medical Group to provide you with CCM, TCM and RPM services.

  • You certify that Priority Medical Group has fully explained the scope of CCM, TCM, and RPM services.

  • You acknowledge that only one practitioner can furnish and be paid for CCM and TCM services during a calendar month.

  • You authorize electronic communication of your medical information between treating providers as part of your care.

  • You understand that CCM, TCM and RPM services are subject to Medicare CO. insurance/other contracted payers and so you may be billed for a portion of the CCM, TCM and RPM services.

  • You understand that you have the right to terminate CCM and TCM services at any time by revoking this agreement effective at the end of the then-current month. You may revoke this agreement verbally by notifying the scheduling team at Priority Medical Group by telephone at (866)740-4777, or by mailing your written revocation to 7620 N. Hartman Lane Ste. 180, Tucson, AZ. 85743. Priority Medical Group will then give you a written notification including the effective date of the revocation.