Managing patients with two or more chronic conditions takes time your front-office team doesn’t have and Medicare only reimburses that time when it’s tracked, documented, and billed correctly. Health XRCM’s chronic care management services give physician practices a done-for-you way to enroll eligible patients, coordinate their care between visits, and bill CMS-recognized CCM codes accurately every month, without adding headcount or software overhead to your practice.
Our team functions as an extension of your practice: identifying eligible patients, managing consent and enrollment, logging non-face-to-face care time, and submitting clean claims. So your providers stay focused on clinical care while a predictable stream of monthly recurring revenue comes in the door.
Chronic Care Management is a care coordination program created by the Centers for Medicare & Medicaid Services (CMS) for patients living with two or more chronic conditions expected to last at least 12 months, or until the patient’s death. Conditions such as diabetes, hypertension, COPD, congestive heart failure, arthritis, chronic kidney disease, and depression.
CCM allows a billing provider to be reimbursed for at least 20 minutes per calendar month of non-face-to-face care coordination. Things like medication review, care plan updates, and communication between specialists delivered personally or by clinical staff acting under the provider’s direction. To bill for CCM, a practice needs:
Get any one of these wrong undocumented times, missing consent, an ineligible patient and the claim is a denial risk. That’s the gap chronic care management solutions like ours are built to close.
We work from your EHR data to identify Medicare and Medicare Advantage patients who meet CCM eligibility criteria, manage the consent process, and get enrollment documented correctly from day one. So every enrolled patient can actually be billed.
Our care coordinators build and maintain individualized, comprehensive care plans, and coordinate with pharmacies, specialists, and community-based providers so care doesn't fall through the cracks between office visits.
Every minute of qualifying care coordination is logged against CMS's 20-minute-per-month threshold, with documentation structured to hold up under a payer audit, not just to trigger a claim.
We handle the coding and claims side of CCM in medical billing directly, applying the correct CPT codes based on time and complexity, checking claims against payer rules before submission, and following up on any that are denied or underpaid.
Behind the scenes, our workflow runs on ccm software for health care that timestamps care coordination activity, flags patients approaching (or missing) their monthly time threshold, and gives your practice visibility into enrollment numbers, time logged, and monthly billing performance.
Because CCM billing is time-based and audit-sensitive, we validate eligibility, consent status, and documentation before a claim goes out, not after it's denied — which is where most CCM revenue actually gets lost.
CCM in medical billing refers to billing CMS for the non-face-to-face care coordination time a provider or clinical staff spends managing a patient's chronic conditions each month.
Yes, CCM can generally be billed alongside an Annual Wellness Visit or other E/M visit in the same month, provided the CCM time and the visit's services are documented separately and don't overlap.
Any two or more chronic conditions expected to last 12 months or more (or until death) that place the patient at risk of decline, hospitalization, or death.
CCM requires two or more chronic conditions; PCM is for a single high-risk chronic condition requiring focused, ongoing management; the two programs use different CPT codes and can't be billed for the same condition in the same month.
Yes. Patients must give verbal or written consent to enroll in CCM before billing begins, and that consent must be documented in the patient's record.
