Since the introduction of CPT 99490, the Centers for Medicare & Medicaid Services (CMS) has expanded the Chronic Care Management (CCM) program, making it easier for practices to generate recurring revenue while enhancing care for at-risk patients. If your practice is considering offering CCM services, it’s crucial to understand the latest program requirements and decide whether to manage CCM in-house or partner with one of the chronic care management companies specializing in these services.
CCM Benefits Your Patients and Your Practice
Chronic conditions remain the leading health challenge in the U.S., especially among Medicare beneficiaries. CMS continues to refine CCM guidelines to incentivize providers, improve patient outcomes, and reduce overall healthcare costs. Key benefits of a CCM program include:
- Improved patient outcomes – Enhanced care coordination leads to better quality of life for patients with multiple chronic conditions.
- Revenue opportunities for providers – Capture reimbursement for non-face-to-face care services already being provided.
- Reduced healthcare costs – Decreased hospitalizations and emergency visits benefit both CMS and patients.
- Lower patient expenses – Reduced out-of-pocket costs for services such as medication management and care coordination.
Should You Manage CCM In-House or Partner with a CCM Provider?
Before deciding whether to build an internal CCM program or partner with an external provider, evaluate your practice’s readiness:
- Do you have enough eligible patients? CCM requires billing providers to manage two or more chronic conditions per patient. Ensure your patient volume supports the program’s sustainability.
- Do you have sufficient staff? CCM requires clinical personnel, 24/7 patient access, and ongoing care coordination. Assess whether your team has the bandwidth to support this.
- Do you have the necessary expertise? To comply with CMS guidelines, your staff must be able to provide patient education, medication reconciliation, and care coordination while adhering to evolving CCM regulations.
- Do you have the right technology? CMS requires practices to track time spent on CCM activities, coordinate care effectively, and submit claims using Certified Electronic Health Record Technology (CEHRT). Ensure your EHR supports these functions.
- Can you manage the overhead costs? Factor in payroll, technology fees, training, and compliance costs. If in-house CCM is too resource-intensive, outsourcing may be the better option.
If one or more of these areas present challenges, partnering with a chronic care management company can help your practice provide compliant and efficient CCM services.
What to Look for in Chronic Care Management Companies
If you choose to outsource, look for a CCM partner that provides:
- Comprehensive CCM services – From patient enrollment to care planning, documentation, and billing support.
- 24/7 patient access – Ensures compliance with CMS requirements and enhances patient care.
- Technology integration – A user-friendly platform that integrates with your EHR for seamless communication and reporting.
- Scalable and customizable services – Solutions tailored to fit your practice’s workflow without disrupting clinical operations.
A qualified CCM partner should function as an extension of your practice, improving care quality while reducing administrative burden.
Partnering with BlueFish Medical
BlueFish Medical simplifies CCM for healthcare providers, offering an end-to-end solution that maximizes patient care and practice revenue. Our services include:
- Licensed nursing staff who manage CCM services while ensuring compliance with CMS guidelines.
- Seamless technology integration that tracks time, care coordination, and claims submission.Let’s change this to documents monthly CCM notes in your EHR so that patient care is seamless for the provider and clinical team
- 24/7 patient support, ensuring continuity of care and compliance with CMS mandates.
Providers partnering with BlueFish Medical typically see an average net revenue of $55 per patient per month for CCM services. For a practice with 500 CCM-eligible patients, this translates to approximately $27,500 per month ($330,000 per year) in additional revenue.
BlueFish operates on a revenue-sharing model, allowing practices to benefit from CCM reimbursement without added overhead. Our focus is on improving patient health while driving financial growth for your practice.
Start Your CCM Program with BlueFish Medical
If you’re ready to implement a CCM program, BlueFish Medical can help you navigate the process with ease. Contact us today to learn more about how we can support your practice in delivering high-quality, profitable chronic care management services.
Request more information by filling out the form below.
Editor’s Note: Updated February 2025