Chronic Care Management
Chronic Care Management
Approximately 170 million Americans have chronic disease. Chronic Care Management (CCM) refers to a comprehensive care plan that addresses chronic health issues. CCM addresses timely preventative care, care plan adherence, coordinated community services, medication management, and the coordination of care.
Our Difference
MD Revolution’s CCM programs have been proven to reduce cardiac hospitalization rates by 50% and deliver a 5-to-1 ROI. We’ve achieved this by enabling a multichannel, high touch patient experience, and data insights from existing apps and monitoring devices, including Apple HealthKit, FitBit, and Dexcom and Libre CGM devices.
Our CCM programs enable on-going patient support and guidance from a care manager, digital and telephonic communication, individualized care plans and health content, and patient access to applications for personal health tracking, goal setting, and secure communication with their care manager.
Programs are designed to ensure compliance with Medicare requirements, enhance practice outcomes and provide additional service revenue, seamlessly integrated into your existing workflow.
CCM programs can be delivered unilaterally or combined with additional programs. Our experience strongly validates providing patients with more comprehensive, whole-person care. Turnkey solutions utilizing our platform, tools, connected devices and services can be configured and scaled up or down to meet the unique needs of patient populations and individual disease states.
Medicare Billable Codes
We enable provider reimbursement for the following CPT codes:
- 99490: Covers the first 20 minutes of CCM services provided by clinical staff per month
- 99439: Covers each additional 20 minutes of CCM services provided by clinical staff, billed in conjunction with 99490
- 99487: Covers the first 60 minutes of complex CCM services provided by clinical staff
- G0506: Covers additional work by the billing provider, such as initiation visits and CCM care planning
- G0511: For Rural Health Clinics or Federally Qualified Health Centers (RHC or FQHC) only, 20 minutes or more of general care management provided by clinical staff. G0511 incorporates multiple codes to keep costs down, covering services for Chronic Care Management and many more.
Chronic Care Management Features + Benefits
Universal EHR Integration
Programs incorporated into the provider’s workflow without interruption
Rapid Service Deployment
Aid providers in identification of qualified patients and assist with the enrollment process
Individualized Care Plans
Evidence based clinical goals and interventions, with task-based assessments
Efficiency & Scalability
Provide clinical staff that allow providers to reach more patients, or our software to power your teams
Engage & Encourage Self-Management
Guide patients to timely preventative care through telephonic coaching and digital patient engagement
Respond to Care Gaps
Identify trends in patient reported vitals and other social determinants of health
