Chronic care management (CCM) is a critical component of healthcare that can help to improve health outcomes and overall quality of life for your patient.  

Under the supervision of a Qualified Health Professional (QHP), our clinical staff will follow an individualized, comprehensive care plan for each patient. Care teams can work directly in your EHR to document care management activities while using our state-of-the-art time-tracking software to maximize your reimbursement.

We communicate with your patient regularly and coordinate with your staff for any intervention that needs to take place (virtual/phone call) You and your team have access to the patient's record anytime.

Improve patient outcomes and reduce hospital readmissions by monitoring patients from anywhere.

New Medicare RPM guidelines expand eligibility criteria with reduced reporting requirements, resulting in healthier patients and increased profitability.

 

Better outcomes and quality of life for your patients and increased revenue for you.

 

Patient Eligibility

● Eligible CCM patients will have multiple (2 or more) chronic conditions expected to last at least 12 months or until the patient’s death and or that place them at significant risk of death, acute exacerbation and or decompensation, or functional decline

● These services aren’t typically face-to-face and allow eligible practitioners to bill at least 20 minutes or more of care coordination services per month

 ● Billing practitioners may consider identifying patients who require CCM services using criteria suggested in CPT guidance (like number of illnesses, number of medications, repeat admissions, or emergency department visits) or the typical patient profile in the CPT prefatory language

● CCM services can also help reduce geographic and racial or ethnic health care disparities Examples of chronic conditions include, but aren’t limited to:

● Alzheimer’s disease and related dementia

● Arthritis (osteoarthritis and rheumatoid)

● Asthma

● Atrial fibrillation

● Autism spectrum disorders

● Cancer

● Cardiovascular disease

● Chronic Obstructive Pulmonary Disease (COPD)

● Depression

 ● Diabetes

 ● Hypertension

● Infectious diseases like HIV and AIDS