What is Chronic Care Management?
Initial Consultation and
Risk Assessment
We provide a monthly phone call conducted by one of our RNs. We first identify the patient’s risk level based on a thorough questionnaire and based on this assessment, established the patient’s health-related goals.
Ongoing 24/7/365
Patient Support
In addition to 24/7/365 text and call support, our RNs will help schedule doctors appointments, provide ongoing education, ensure medication adherence and provide ongoing accountability.
Bill the Payer for
Providing CCM
Our clinical interactions with your patients generates time towards the time-based CCM codes that you will bill Medicare (or other payer) for monthly. We help you with billing details so that you can generate clean claims.
Who monitors the patient data?
Our Clinical Team
- 24/7/365 coverage in all states
- English and Spanish speaking
- Follow clinic-guided escalation processes
- Scale your RPM/CCM program without hiring additional staff
- Operates as an extension of your practice
Our Software
- Integrates with cloud-based EHRs
- Time stamps and records patient interactions
- Generates billing reports
- Receives patient vitals
- Records clinical staff notes
How much will get reimbursed for CCM?
Monthly
20 Minutes - CCM
99490: Initial 20 minutes of clinical staff time. Average $64.
40 Minutes - CCM
99439: Subsequent 20 minutes of clinical staff time. Average $48.
60 minutes - CCM
99439: Subsequent 20 minutes of clinical staff time. Average $48.
How will this benefit our patients?
-16 mgdl
Our clinic's average blood glucose improvement overtime
-11 mmhg
Average systolic blood pressure improvement overtime
-9 mmhg
Average diastolic blood pressure improvement overtime
-4 bpm
Average resting heart rate improvement overtime
-17 lbs
Average weight loss improvement overtime
22%
Medication adherence increase
How will you keep our patients engaged?
Automated Reminders
In addition to our live agents who call patients, our automated reminder system will send SMS reminders to patients to remind them to take their readings.
Consumables Included
We supply patients with consumables for their devices, including batteries, diabetic lancets and test strips as part of our service.
Care Coordinators
When enrolled in our CCM program, every patient will be assigned their own personal care coordinator. Developing a trusting, and meaningful relationship with patients will ensure long-term adherence.
How do we get started?
Receive Analysis
Receive a complimentary analysis of how many patients qualify for RPM and CCM, along with your estimated costs and reimbursement.
Ship Devices
Once patient consent has been obtained, will ship devices and consumables to your patients' homes.
Get Reimbursed
We'll provide a monthly billing report so your biller can easily generate RPM and CCM claims.
Get Consent
Our team will call patients to educate them about RPM and CCM and obtain their consent.
Monitor
Our RNs will call your patients when their readings are abnormal and escalate appropriate ones to your attention.