CMS-Compliant Chronic Care Management (CCM) Services
At CareIQ, we provide chronic care management services designed to transform how healthcare providers deliver care to patients living with multiple chronic conditions. Our solution combines advanced technology, expert clinical staff, and CMS-compliant workflows to make care coordination seamless. With CareIQ, practices don’t just manage chronic illnesses—they empower patients, strengthen engagement, and unlock sustainable revenue streams. Whether you’re a family physician, nurse practitioner, or part of a large healthcare network, our chronic care management platform simplifies care delivery while improving patient outcomes.
What is Chronic Care Management (CCM)?
Chronic care management (CCM) is a CMS-recognized service that provides ongoing support for patients with two or more chronic conditions expected to last at least 12 months. These conditions may include diabetes, hypertension, COPD, heart disease, and more. By offering structured monthly care coordination, providers help patients achieve better health outcomes, avoid hospitalizations, and reduce healthcare costs.
Chronic Care Management Definition
According to the Centers for Medicare & Medicaid Services (CMS), CCM refers to non-face-to-face services delivered by qualified health care professionals and clinical staff. It includes 20+ minutes of care per calendar month, focused on care coordination, medication management, and building a comprehensive care plan.
Why CCM Matters
- More than 133 million Americans live with at least one chronic condition.
- Patients with multiple chronic conditions often need care transition support between providers.
- Coordinated care prevents emergency visits and supports long-term desired outcomes.
- Practices offering CCM see stronger patient loyalty and financial stability.
What is Chronic Care Management (CCM)?
Chronic care management (CCM) is a CMS-recognized service that provides ongoing support for patients with two or more chronic conditions expected to last at least 12 months. These conditions may include diabetes, hypertension, COPD, heart disease, and more. By offering structured monthly care coordination, providers help patients achieve better health outcomes, avoid hospitalizations, and reduce healthcare costs.
CareIQ’s Chronic Care Management Platform
Our chronic care management solution integrates technology, compliance, and human expertise. The platform connects patients, providers, and care managers through one seamless system.
Key Features of the CCM Platform
- Comprehensive Care Plans: Tailored plans aligned with annual wellness visits and updated regularly to reflect changing patient needs.
- Remote Patient Monitoring Integration: Compatible with FDA-approved devices for proactive management of blood pressure, blood sugar, and oxygen levels.
- Secure Documentation: HIPAA-compliant handling of sensitive information with full certified EHR integration.
- Automated Billing: Streamlined CCM billing based on correct CPT codes, reducing administrative burden.
- Customizable Dashboards: Real-time insights into care quality, staff performance, and patient progress.
This platform ensures that providers can identify patients, engage them consistently, and track progress across the care continuum.
Why Choose CareIQ for Chronic Care Management Services?
Improved Patient Outcomes
Our services help patients better manage chronic conditions like diabetes, asthma, or heart failure. With consistent support, patients experience fewer complications, reduced hospital readmissions, and stronger adherence to care plans.
Revenue Growth for Practices
By offering CCM chronic care management services, practices generate additional revenue under Medicare Part B and Medicaid services. With CCM CPT codes, providers can earn $40–$150 per patient monthly. For 100 patients, that equals an annual potential of $54,000–$180,000.
Scalable Care Coordination
Whether you’re a solo physician or part of a large group, CareIQ’s chronic care management platform scales to fit your needs. Our outsourced clinical staff can provide support, ensuring no opportunity for care or reimbursement is missed.
CMS-Compliant Billing Support
We handle compliance with chronic care management CMS guidelines, from patient consent to documentation of CCM activities. Practices can focus on care while we manage compliance.
Our Chronic Care Management Service Model
Patient Enrollment and Identification
Our system helps providers quickly identify patients eligible for CCM, typically during annual wellness visits or routine check-ups. We also provide education so patients understand the benefits and can give informed consent.
Ongoing Care Coordination
Care managers engage patients monthly, addressing urgent needs, updating the care plan, and ensuring the care team is aligned. This reduces gaps in care and prevents avoidable complications.
Integrated Remote Monitoring
CCM is most effective when combined with remote patient monitoring (RPM). Data from connected devices is integrated into the electronic health record, providing providers with real-time alerts to intervene early.
Outsourced Clinical Staff
Our experienced clinical nurse specialists, physician assistants, nurse midwives, and other qualified health care professionals perform CCM tasks. This relieves physicians and expands capacity without adding extra workload.
Billing & Documentation Support
We handle CPT codes, documentation, and compliance for both non-complex CCM and complex CCM. Providers receive maximum reimbursement with minimal administrative effort.
Reporting & Compliance
Every calendar month, we generate detailed reports that document clinical staff time, care coordination activities, and outcomes. This ensures full CMS compliance and audit readiness.
Chronic Care Management CPT & Reimbursement
CMS Chronic Care Management Codes
- 99490: Non-complex CCM, 20 minutes of clinical staff time.
- 99439: Each additional 20 minutes.
- 99491: Time spent by a physician or other qualified health care professional.
- 99487 & 99489: Complex CCM, requiring high-level medical decision making.
Revenue Potential with CCM
By using the appropriate CCM billing codes, practices can increase revenue without increasing in-office visits. This model aligns patient care with provider sustainability.
Maximizing ROI with CareIQ
We ensure accurate coding, billing, and documentation, so providers never miss out on reimbursement opportunities. Our model supports primary care physicians, family physicians, and care managers equally.
About CareIQ
CareIQ, based in Wilmington, Delaware, is a healthcare technology company offering remote patient monitoring, behavioral health integration, and chronic care management services.
Our Mission
To revolutionize healthcare delivery by providing scalable, CMS-compliant care management solutions that improve patient well-being and provider sustainability.
Our Vision
To be the leading partner for chronic care management services across the U.S., enabling providers to achieve better outcomes and sustainable growth.
Provider Testimonials & Success Stories
“Thanks to CareIQ’s chronic care management solution, our patients with chronic conditions now receive consistent support between visits. We’ve seen measurable improvements in outcomes.”
– Family Physician, Florida
“Our practice struggled with CCM documentation until we partnered with CareIQ. Their platform and outsourced staff made it effortless to provide compliant, billable CCM services.”
– Nurse Practitioner, Ohio
“CareIQ’s chronic care management services have transformed the way our care team engages patients. With their coordinated support and streamlined platform, we’ve reduced hospital readmissions and improved overall patient satisfaction.”
– Clinical Nurse Specialist, Texas
Frequently Asked Questions
Get Started with CareIQ’s Chronic Care Management Services
Don’t let the burden of chronic disease management slow your practice down. CareIQ delivers the technology, staff, and compliance expertise you need to transform care delivery.
With CareIQ’s chronic care management services, you can improve patient engagement, achieve compliance, and unlock new revenue opportunities.