Chronic Care Management

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With ChronicCareIQ, your practice can perform chronic care management (CCM) confidently and profitably without adding staff or a third-party call center.

Learn More About CCM Today

boost care quality and connectivity with your chronically Ill patients

Our award-winning technology solution proactively engages your eligible patients and obtains updates about their current health status. A red-yellow-green dashboard alerts staff which patients are trending poorly or are in need of outreach so you can prevent adverse events.

ChronicCareIQ also integrates with your EHR and phone system to ensure all eligible activities and patient contact points are automatically captured, timestamped and documented with the appropriate CCM reimbursement codes.

The result? Better patient outcomes, better documentation, and more secure reimbursements.

Benefits of Chronic Care Management

Reduce administrative burdens for staff
Add new recurring monthly revenue
Identify and prevent disease progression sooner
Prevent ER visits and hospitalizations
Improve quality and comply with specific MACRA quality measures
Increase patient engagement and satisfaction

“If my patients experience changes in their symptoms or report readings that fall outside of our clinical thresholds, I know immediately through my ChronicCareIQ dashboard. I feel that I'm able to do my job much more efficiently and successfully by having a single view into all of my patients in one simple dashboard.”

Donna Hardy, Chronic Care Coordinator, Birmingham Heart Clinic

How it Works

How ChronicCareIQ Enables You to Build a Robust CCM Program

Once patients are enrolled in your care management program, the system begins to proactively engage with them according to the clinical protocols you set for their specific chronic conditions. Engagement comes in the form of a series of simple questions that patients respond to – either on their phone, tablet, or personal computer. And 87% of those who start are still engaged one year later.
As your team provides care and supportive services, such as phone calls, coordinating medication refills, patient education, and care coordination with specialists and testing centers, the system recognizes those interactions and automatically captures and timestamps each activity for reimbursement. Each eligible activity is then assigned the appropriate care management program codes. There is no need for staff to manually provide documentation or follow reimbursement guidelines for hitting certain thresholds – the system does the work for them.
Your clinical team members simply review their red-yellow-green dashboards to know which patients are trending in the wrong direction or those who have exceeded pre-set clinical thresholds. They can drill down to the details of each patient, review recent interactions and see the latest data coming in from patients and/or monitoring devices. This gives them a complete picture of the patient in real-time so they can make more informed decisions about what needs to happen for each patient. Earlier intervention not only improves outcomes and patient satisfaction, it also makes complex patients easier to care for and reduces the burden on staff.
Your back-office staff has access to reports that show which clinical activities were performed on which patients so preparing claims for reimbursement is simple. The system not only quantifies but also qualifies where the time was spent, so you know exactly what to bill for each patient. This helps protect your practice from over or under billing without appropriate documentation. All the pieces come together.

Hear What Our Customers are Saying

ChronicCareIQ is simple to use and gives you the data you need to make the right decisions to care for your patients.

Doctors are not going to be able to live without ChronicCareIQ. The convenience and regular contact with patients is the big key going forward.

I believe the ChronicCareIQ platform is an extremely useful tool that every cardiology practice should utilize.

I’ve really been pleased with our patient retention rate with ChronicCareIQ. Patients are very thankful for it and want to continue using it.

ChronicCareIQ has helped me stay in touch with my patients in between visits, and as a result, we've seen fewer emergencies and hospitalizations.

With ChronicCareIQ, we are better in touch with our patients, and patients feel better knowing that they have daily or regular contact with our office. We have also seen a significant decrease in office call volume.

How ChronicCareIQ Unleashes New Revenue for Your Practice

The old way of operating and funding a medical practice is gone, thanks to a number of factors including the COVID-19 pandemic, the move to value-based care, the aging of Americans, and ongoing cuts to reimbursement. Chronic Care Management, Remote Patient Monitoring, Transitional Care Management and Principal Care Management offer new sources of revenue while helping you deliver better care to your most medically fragile patients – even when they can’t come to the office.

Chronic Care Management CPT Billing Codes

(as of CMS FY2022 Fee Schedule)

CPT 99490 – $64 (Increased 2022)
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
Comprehensive care plan established, implemented, revised, or monitored

CPT 99439 – $48 (Increased 2022)

Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (limit 2x during service period)

CPT 99487 – $134 (Increased 2022)
Complex chronic care management services, with the following, required elements:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
Comprehensive care plan established, implemented, revised, or monitored, Moderate or high complexity medical decision making
First 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

CPT 99489 – $70
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

HCPCS G0506 – $63
Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)