Do you know how much Medicare spends on treating chronic conditions?

The estimated numbers will actually surprise you. You see, out of the $4.5 trillion healthcare budget, $1 trillion is almost spent on chronic conditions and mental health. As a healthcare provider, this presents a perfect opportunity to start a CCM program and maybe add another source to your revenue streams.

While many healthcare providers have started a CCM program to capitalize on this revenue opportunity, there are still many providers who miss out on this. The question you should be asking here is, how can chronic care management programs help me unlock the hidden medical revenue?

The key to unlocking this lies in Chronic Care Management software, but why?

Well, a CCM software can systematically capture and maximize medicare reimbursements. Let’s see how in this blog below:

The Medicare Revenue Opportunity in Chronic Care Management

According to the current Medicare structure for chronic care management programs, there are four CPT codes and one HCPCS code. Now, getting into the intricacies of each of the codes will give you a brief idea about the CCM program and how it works. Refer to the table below:

Code	Description	Time Requirement	Who Can Bill	Reimbursement (Approx.)
99490	CCM services for at least 20 minutes of clinical staff time	≥20 minutes/month	Primary care or specialist	~$62
99439	Add-on: Each additional 20 minutes of clinical staff time	Each additional ≥20 minutes	Same as above	~$47
99487	Complex CCM: 60 minutes of clinical staff time with moderate/high complexity	≥60 minutes/month	Physician or qualified healthcare professional	~$135
99489	Add-on to 99487: Each additional 30 minutes	Each additional ≥30 minutes	Same as above	~$72
G0506	Comprehensive assessment and care planning (only once per patient)	N/A – per episode	Physician or QHP	~$64

Market Size & Untapped Potential

Now, given the number of patients suffering from chronic conditions, the market is still vast for the CCM platforms. This is because only 40% of the eligible medicare patients were enrolled in CCM services that too in 2021.

Though this number has increased, there is still a huge market that remains untapped. Coming to the revenue aspects, on average, the practice would reach a revenue of $50,000 to $200,000 annually.

And for achieving this, let’s see how a CCM revenue model can be beneficial over a fee-for-service model:

Aspect	Fee-for-Service (FFS)	CCM Model
Billing	Per in-person visit	Monthly recurring
Interaction	Episodic	Continuous & remote
Time Use	Physician-driven	Staff-led coordination
Scalability	Limited by visit slots	Easily scalable
Annual Revenue Potential	Visit-based	~$50K–$200K per 100–300 patients

Why Providers Miss Additional Revenue Opportunities?

There are several reasons that lead to providers missing out on additional revenue opportunities, and most of these can be tracked back to the chronic care management solutions. You see, with a complete CCM software, administrative burden increases on the staff members and billers. This increases the margin of error, leading to more mistakes.

On top of that the lack of patient identification and enrollment processes in the chronic care management platform, just adds up to the untapped market. And last but not least, insufficient care coordination and documentation workflows also leads to missing out on the existing opportunities.

How CCM Software Automates Revenue Capture

One of the solutions to NOT miss out on the existing and additional revenue capturing opportunities can be implementation of chronic care management software with automation processes. But how can a CCM software with automation capabilities can help you increase your revenue?

Well, let’s find out.

• Automated Patient Identification & Eligibility Screening: AI-powered systems are great at analyzing and identifying patterns and trends in data. With your chronic care management platform being integrated with EHR systems, it can easily point out eligible patients and automate assigning codes based on care services provided. This not only helps in reducing the risk but also reduces manual charting review time by 80%.
• Streamlined Care Plan Creation & Management: With care management software, you don’t have to worry about meeting the CMS requirements of care planning, as pre-defined templates make it easier for you. On top of that, with automation functionality, the care plans can be easily updated after physicians’ approvals, bringing everyone on the same page.
• Real-Time Billing & Documentation Tracking: Automation combined with a time tracking feature can further streamline the billable CCM activation, making it easier for your staff members. Along with that, with a CMS-compliant documentation generation, the documentation process can also be streamlined and done almost instantly. These activities also make revenue forecasting and reporting easier, especially with dedicated dashboards.
• Patient Engagement & Communication Workflows: It can also be used to keep the patients in their care journey with automated appointment reminders and follow-up scheduling. This, combined with secure messaging and telehealth integration, not only gives patients a complete experience and access to the patient portal for care plan review and update, but also further makes the process easier.

Key Features That Maximize Medicare Reimbursements

To maximize the medicare reimbursement rate, your chronic care management software must have some of these features. Let’s learn and discuss them briefly below:

• CMS Compliance & Audit Readiness: There are certain medicare billing requirements that you must adhere to. These built-in compliance checks can make the process of claims submission much easier. Along with that, there is automated audit trail creation and document storage. However, you must regularly update the structure with respect to the changing CMS regulations and fee schedules.
• Multi-Provider Care Coordination Capabilities: Your CCM software will also be used as a patient care management software, which enables you to manage patients from one point across different care teams. This way, task assignment and tracking of nurses, care coordinators, and physicians becomes much easier and sophisticated. On top of that, with a centralized chronic care management platform, inter-provider communication and handoff protocols can be easily updated.
• Advanced Reporting & Analytics: Many chronic care management software systems come with reporting and analytics capabilities. These features enable revenue performance tracking, provide optimization insights, and can be crucial for determining patient outcome metrics and ensuring quality. With this tracking provider, productivity and efficiency are also possible.
• Integration with Existing Practice Management Systems: One of the crucial features that you must have in your CCM software is integration with EHRs and billing systems. This is crucially important for care delivery and reducing duplicate data entries and administrative overheads. Furthermore, with a unified patient record and care history, the other aspects of care delivery become much easier.

Implementation Strategy for Maximum ROI

Other than just having a chronic care management telehealth software, the right implementation of the software is also crucial to capitalize on the ROI aspects. Here are the three implementation phases that can give you an opportunity to maximize your ROI:

• PHASE 1 – Patient Identification & Enrollment: The first phase obviously involves a systematic review of the patient population for CCM eligibility. Now, coupling this with automated outreach campaigns to get their consent can fast-track your program growth. For the success of this phase, staff training on the CCM program benefits and the enrollment process is necessary.
• PHASE 2 – Workflow Optimization & Staff Training: Typically, in a chronic care management program, many healthcare providers are involved. That is why it becomes necessary for you to define the care coordinator role and map their responsibilities effectively. Furthermore, depending on your practice’s unique workflow, you must customize the workflow and provide training on CCM billing requirements and the documentation process.
• PHASE 3 – Monitoring & Optimization: The last and most important phase is a slightly laid-back and relaxed phase. In this phase, most of the aspects involve monitoring and optimizing your processes and workflows. For this, a regular performance review is required to track revenue. Apart from the financial aspects, you must also monitor the patient engagement metrics and satisfaction monitoring, so that you have everything in place. And in case you find any loopholes or scope for improvement, then you need to proactively improve that along with workflow refinement, keeping everything in place.

Choosing the Right CCM Software Platform

Choosing the right chronic care management software is also crucial for capitalizing on the reimbursement opportunities. And this is where most of the people go wrong, so here are some of the things that you must consider while choosing the right CCM software platform:

• Essential Features Checklist: Learn about the features and functionalities you get with the chronic care management solution. For an advanced version of the software, ask for CMS compliance and billing automation capabilities. Along with that, check for necessary features like EHR integration, adherence to the interoperability standards, and a care coordination workflow and reporting tools.
• Evaluation Criteria for Software Selection: Chronic care management software pricing has different models, and the total cost of ownership varies according to the model. That is why you need to have an evaluation criterion to make the right decision. Consider implementation time, and support services along with the options they provide for scalability and customization.
• Questions to Ask Potential Vendors: It is always one of the best practices to ask questions to your vendors. Some of the questions that must be included in your questionnaire are about compliance track record and audit support, training process, ongoing support availability, and integration capabilities with existing practice systems.
• Red Flags to Avoid: Some of the red flags that you must avoid are a lack of CMS compliance certification, limited integration capabilities, or single practice use data formats. These things can only complicate the process and leave you little to no room for customization. Last but not least, if the vendor has inadequate customer support and training, take that as a big red flag.

Conclusion

If you’ve made it till here, then you must have got an idea that there is an untapped revenue stream in chronic care management telehealth and you are just the right CCM software away from exploring it.

However, you must have also got an idea about how care management software needs to be implemented to truly increase our revenue. And if you have an CCM program in place, then all you need is a nudge in the right direction. On that note, let’s start your program in the right direction, with your first free consultation. Click here to get started.

FAQs

1. How much can my practice earn through Medicare CCM programs?

A practice can earn significant revenue through Medicare CCM programs. For 2025, reimbursement for non-complex CCM (CPT 99490) is about $60.49 per patient per month for 20 minutes, with additional codes for more time. Complex CCM (CPT 99487) can yield around $134.15 for 60 minutes. Practices with 250 enrolled patients could generate $150,000-$352,500 annually.

2. What are the CMS requirements for CCM billing?

CMS requires CCM billing for patients with 2+ chronic conditions expected to last 12+ months or until death, posing significant health risk. Providers must obtain patient consent, establish a comprehensive care plan, and deliver at least 20 minutes of non-face-to-face services per month (clinical staff or physician time, depending on the CPT code).

3. How long does it take to implement CCM software and see results?

Implementing CCM software can take anywhere from a few months for simpler solutions to over a year for complex, enterprise-wide deployments. Results, such as improved customer experience and operational efficiency, can start to be seen incrementally during the implementation, with significant ROI often realized within 12-18 months.

4. Can CCM software integrate with our existing EHR system?

Yes, CCM software can integrate with existing EHR systems. This integration streamlines workflows, centralizes patient data, enhances care coordination, and simplifies billing, providing a holistic view of patient health and improving efficiency.