PAYER GUIDE

Patient cost share and consent are part of a respectful program—not an afterthought.

A care-management program works best when patients understand why they are being offered it, what contact to expect, how to pause non-urgent outreach, and any potential financial responsibility.

Design a patient-ready workflow

WHAT TO EXPLAIN BEFORE ENROLLMENT

Clarity protects trust.

Original Medicare beneficiaries may have Part B deductible and coinsurance responsibility for covered care-management services. Medicare Advantage, Medi-Cal, commercial, supplemental coverage, and contractual arrangements can change what the patient owes.

Explain the clinical purpose and how the program fits the patient’s existing care team.

Verify coverage and communicate any potential patient responsibility before enrollment; do not quote a universal amount.

Capture the required consent and a patient’s preferred language, channel, contact timing, and frequency.

Offer a clear way to ask questions, decline, or pause non-urgent outreach while preserving clinically necessary escalation.

MEDICARE EXAMPLE

Use the actual approved amount—not a marketing estimate.

Medicare.gov notes that, for chronic care management, beneficiaries generally pay the Part B deductible and 20% of the Medicare-approved amount after the deductible. Other coverage can change that responsibility.

Read Medicare’s chronic care management coverage information

DESIGN A PRACTICAL STARTING POINT

Tell us where the workflow is breaking. We’ll show you where to begin.

Choose how to connect

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