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Clinical Operations Guide
Chronic Care Management (CCM) Workflow & Revenue
Learn how to implement a high-performing CCM program that improves patient outcomes and adds a predictable, monthly revenue stream across Medicare and Private Insurance payers.
How CCM Care is Performed
A simplified 4-step workflow for clinical teams.
Patient Enrollment
Identify patients with 2+ chronic conditions. Obtain verbal or written consent and document it in the system. Our platform makes this a 2-minute process.
Care Plan Creation
Develop a comprehensive care plan directed at all health concerns. The platform provides smart templates based on diagnoses to ensure CMS compliance from day one.
Monthly Care Management
Provide 20+ minutes of non-face-to-face care per month. This includes phone check-ins, remote chart reviews, and coordination with laboratories or specialists.
Automated Billing
Once the 20-minute threshold is triggered, the system flags the patient for billing. One click generates the multi-payer claims and PDF attestations.
Revenue Potential
How Much You Can Earn
CCM provides a predictable monthly revenue stream. Unlike office visits, CCM is billed every single month as long as clinical criteria are met.
CPT 99490
Initial 20 Minutes (Staff)
~$62
Per Patient / Month
CPT 99439
Each Add'l 20 Minutes
~$47
Additional Unit
CPT 99491
Initial 30 Minutes (Provider)
~$85
Per Patient / Month
Annual Revenue Example
Patients Enrolled
100
Avg Reimbursement
$62
Estimated Monthly Revenue
$6,200
Estimated Gross Annual Revenue
$74,400
Note: Actual rates vary by geographic location and CMS adjustments. These figures are based on 2024 national averages.
Medicare vs. Private Insurance
While Chronic Care Management was pioneered by CMS (Medicare), most major private insurance carriers now recognize and reimburse for CCM services using the same CPT codes.
Medicare (CMS)
The baseline for compliance. Medicare covers 80% of the CCM rate, with the remaining 20% covered by supplemental insurance or patient co-pay.
Commercial Payers
Aetna, BCBS, Cigna, Humana, and UnitedHealthcare generally reimburse for CCM. Rates can often be higher than Medicare depending on your specific contracts.
Medicare Advantage
Managed by private insurers but following Medicare rules. These plans are required to cover CCM and often have streamlined authorization processes.
Why follow CMS rules for everyone?
We build our platform to meet **Medicare's strict auditing standards** because they are the most rigorous.
- If you are audit-ready for Medicare, you are ready for any payer.
- Simplified clinical workflows by using one standard for all patients.
- Maximum risk mitigation against clawbacks and recoupment.
When is a Code "Completed"?
Most payers (including Medicare) require **20 minutes of non-face-to-face clinical staff time** per calendar month to bill the base CCM code (99490).
Automated Time Tracking
CareReimburse tracks every minute spent on phone calls, chart reviews, and coordination automatically.
Real-time Completion Alerts
The dashboard notifies you the moment a patient reaches the 20-minute threshold.
Consent: SIGNED
Care Plan: UPDATED