Chronic Care Management (CCM)

Care 24/7 provides Chronic Care Management (CCM) services and Transitional Care Management (TCM) for Medicare patients who meet the requirements laid out by CMS. There are no up-front capital costs associated with either service. Care 24/7 provides a turn-key business model focused on patient-centered care coordination and only invoices your practice or system when all billable requirements are met.

Care 24/7 Wellness Coordinators regularly check in on recently discharged patients, as well as patients suffering from chronic conditions, coordinate all aspects of care, and help patients and their caregivers follow their doctor’s care plan.

CCM Chronic Conditions

Patients who meet the following criteria are eligible for Care 24/7 Chronic Care Management (CCM) Services:

  • Medicare-Eligible Beneficiaries
  • Have Two or More of the Following Chronic Conditions:
    • Acquired Hypothyroidism
    • Acute Myocardial Infarction
    • Alzheimer’s Disease
    • Alzheimer’s Disease & Related Disorders or Senile Dementia
    • Anemia
    • Asthma
    • Atrial Fibrillation
    • Benign Prostatic Hyperplasia
    • Cataract
    • Chronic Kidney Disease
    • Chronic Obstructive Pulmonary Disease & Bronchiectasis
    • Depression
    • Diabetes
    • Endometrial Cancer
    • Female/Male Breast Cancer
    • Glaucoma
    • Heart Failure
    • Hip/Pelvic Fracture
    • Hyperlipidemia
    • Hypertension
    • Ischemic Heart Disease
    • Lung Cancer
    • Osteoporosis
    • Prostate Cancer
    • RA/OA (Rheumatoid Arthritis/Osteoarthritis)
    • Stroke/Transient Ischemic Attack

Care 24/7 will work with the Provider or Hospital System to help maintain wellness of their patients. We will ensure that the questions of your patients are answered, and that they are following the suggested wellness plan as instructed by their Provider.  Care 24/7 staff members are available around the clock to provide your patients with assistance, day or night.


Care 24/7 works with the Provider or Hospital System to make sure patients are achieving chronic wellness.

Our Wellness Coordinators will contact your enrolled patients by phone, as needed, to:
  • Remind Patients Of Appointments
  • Reconcile Medications
  • Schedule Appointment For Patients (In The Event Patients Must See A Specialist)
  • Insure That Patients Receive Their Immunizations On Time
  • Answer Patients Questions
  • Facilitate Any Assistance Your Patients May Need

Maximize Your Value – Calculate Your Revenue Potential for CCM

The CCM Calculator can assist the Provider or Hospital System in calculating the potential revenue for patients services completed.

2017 UPDATE: 99490 is just one way in which CMS is reimbursing Providers and Hospital Systems for providing Care Coordination Services. Additional codes (CPT code 99487 and 99489), for expanded time are available for usage with moderate and high complexity medical decision making patients. If interested in learning more about complex CCM and new enrollment options for 2017, contact us using the form below.

Rates listed as the default in the CCM Calculator are based on U.S. averages as expressed by

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