How CCM Works — Innovosoltech
A Complete Walkthrough

CCM, step by step.
Nothing left out.

From the moment a patient file arrives to the billing package sent — every step our team handles on your behalf, every month, for every enrolled patient.

Medicare-Covered

Zero cost to patients. Secondary insurance handles any copay.

Fully Documented

Every interaction recorded, transcribed, and audit-ready.

Monthly Cycle

Steps 3–8 repeat automatically each month until unenrollment.

The Programme

What is Chronic
Care Management?

A Medicare Part B covered monthly coordination programme — run entirely by our team on behalf of your physicians.

Monthly check-in coordinated by a dedicated care coordinator on behalf of the physician

Phone, email, and text outreach each month — call always attempted first

Covers medication adherence, vitals, therapy, specialist visits, and emotional well-being

Coordinates with PCP, home health, pharmacy, family, RPM providers, and assisted living

Every interaction recorded, transcribed, summarised — billing package prepared monthly

1

Active Medicare Part B

Patient must have Medicare as primary insurance

2

Secondary Insurance

Ensures zero out-of-pocket — we verify before first contact

3

2+ Chronic Conditions

e.g. Diabetes + Hypertension, CHF + CKD, COPD + Anxiety

4

Enrolled by Physician’s Office

We receive the referral — we do not self-enroll patients

Zero cost to patient. Medicare covers it. Any copay is handled by secondary insurance.

End-to-End Process

The monthly CCM cycle

Every patient follows this structured cycle — repeated until the patient unenrolls. Steps 03–08 run every month.

01

Patient File Received

Doctor’s office sends care plan, insurance details, and patient chart to our team

02

Care Plan & Questionnaire

Detailed care plan created. Month-1 questionnaire tailored to patient’s specific conditions

03

First Call Attempted

Coordinator calls patient — explains CCM, verifies consent and confirms insurance coverage

04

Email & SMS Fallback

Per CCM guidelines, email + text sent same day if call goes unanswered

05

Care Coordination

Contacts PCP, home health, pharmacy, family, RPM provider, and assisted living as needed

06

Call Recorded & Transcribed

Every interaction recorded with consent, transcribed, and summarised via NeuralWave AI

07

Physician Review

Physician reviews notes, escalations flagged and handled, EHR updated if access given

08

Billing Package Sent

Summary + time log + evidence sent to billing. CPT 99490 / 99439 submitted to Medicare

↻   Steps 03–08 repeat every month until the patient unenrolls. Questionnaire rebuilt monthly from prior month’s summary + care plan.
Inside Each Step

Real patient. Real workflow.

A live example — Robert Martinez, age 73, Type 2 Diabetes + Hypertension + CHF.

Input — Patient File from Doctor’s Office
NameRobert Martinez
DOB09/14/1951  (age 73)
Medicare ID1EG4-TE5-MK72
Secondary Ins.Confirmed active
ConditionsType 2 Diabetes, Hypertension, CHF
MedicationsMetformin, Lisinopril, Furosemide, Carvedilol
PhysicianDr. S. Patel — 770-555-0142
Home HealthBrightCare — PT 3×/wk, RN 1×/wk
RPMDaily BP + weight via VitalTrack
PharmacyMediQuick Rx — 404-555-0198
Discharge03/10/2025 — post CHF admission
Output — Month-1 Questionnaire

Tailored to care plan conditions:
Condition 1: Diabetes T2 — FBG 80–130 mg/dL, HbA1c < 7.5%
Condition 2: Hypertension — BP < 130/80 mmHg
Condition 3: CHF — stable weight, no fluid overload

Ankle/leg swelling — improved since discharge?
Taking Furosemide, Metformin, Carvedilol as prescribed?
Daily weight — any sudden 2+ lb gain?
Shortness of breath at rest or with activity?

Step 03 — First Phone Call

Recorded · HIPAA Compliant
CC
Good morning — may I speak with Mr. Martinez? This is the Care Coordinator calling from your physician’s office. Please note this call may be recorded for quality and compliance purposes.
RM
Yes, this is Robert.
CC
I’m calling about your Chronic Care Management program — it’s fully covered by Medicare, and your secondary insurance covers any remaining copay, so there’s no out-of-pocket cost to you. Do you consent to continue?
RM
Yes, that sounds fine.
CC
You were recently discharged after your CHF admission. Any swelling in your ankles or legs?
RM
Some swelling still, but less than before. I watch my weight daily — around 187–189 lbs. BP averaging 128/80.
CC
Both look stable. Taking all your medications — Furosemide, Carvedilol, Metformin — as prescribed?
RM
Yes, every day. My daughter sets them out for me.
Step 04A
Email Fallback

Dear Mr. Martinez, we attempted to reach you by phone today. This is your first monthly CCM check-in — fully covered by Medicare, with any copay covered by your secondary insurance, at no out-of-pocket cost. Quick questions: any ankle swelling or shortness of breath? Taking Furosemide, Metformin, and Carvedilol as prescribed? Please reply or call 555-800-1234.

Step 04B
SMS — Same Day

Hi Mr. Martinez — this is your Care Coordinator from your physician’s office. We tried calling for your monthly CCM check-in (fully covered by Medicare, no out-of-pocket cost). Quick questions: ankle swelling improving? Taking all meds? Recent weight + BP? Any shortness of breath? Please reply or call 555-800-1234.

After every patient interaction we coordinate with the full care network — PCP, home health, pharmacy, RPM provider, family, caregiver, and assisted living where applicable.

PCP

Dr. S. Patel

Notified: residual ankle swelling, BP avg 128/80
Requested: med review — Furosemide dose adequate?
Response: monitor at next visit 04/02, no changes yet
Home Health

BrightCare

PT 3×/wk and RN 1×/wk confirmed active
Requested 7-day weight log from RN
RN report: weight stable 187–189 lbs, no fluid concerns
Family

Daughter Maria

Confirmed patient compliant with low-sodium diet
Caregiver assistance with daily medications confirmed
Assisted living facility notified of care plan and schedule
Pharmacy

MediQuick Rx

All scripts filled: Furosemide 40mg, Metformin 1000mg, Lisinopril 10mg, Carvedilol 6.25mg
No refill issues. Next refill due 04/10.
RPM

VitalTrack

7-day data: BP avg 130/82, weight stable at 188 lbs
SpO2 consistently 96–98%. No alerts triggered.
Data shared with physician for monthly review
Physician

Escalation Review

Escalated: mild exertional dyspnea still present
Decision: continue regimen, recheck month 2
No immediate intervention needed
Step 06 — Conversation Summary
PatientRobert Martinez  |  DOB: 09/14/1951  |  Date: 03/19/2025
HealthAnkle swelling improving. No SOB at rest. Weight 187–189 lbs, BP avg 128/80 (VitalTrack).
MedicationsFurosemide, Metformin, Lisinopril, Carvedilol — all taken daily. Daughter assists.
TherapyBrightCare PT 3×/wk + RN 1×/wk active. RPM device stable, no alerts triggered.
EscalationMild exertional dyspnea flagged. Physician response: continue regimen, reassess month 2.
StatusNo falls. Emotionally stable. Strong caregiver support at home.
NeuralWave AI → auto-transcript → summary → EHR updated
Step 07 — Time Log
Intro, consent & CCM explanation3 min
Medication review & adherence4 min
Symptoms & vitals (CHF, BP, weight)4 min
Home health & therapy coordination4 min
Family & pharmacy follow-up3 min
Record review & documentation2 min
Physician review (Step 07)5 min
Total Billable Time25 min
CPT 99490 / 99439  →  Submitted to Medicare
Step 08 — Billing Package Sent to Billing Department

Patient summary with health updates and care actions

Time log: 20 min coordinator + 5 min physician = 25 min total

Call recording file (audio evidence)

Auto-generated transcript (text evidence)

RPM data export from VitalTrack (supporting evidence)

Billing team submits CPT 99490 / 99439 to Medicare

Month 2 Questionnaire — Built from Month 1 Summary
Last month: mild exertional dyspnea — better, worse, or same?
Ankle swelling — still present or fully resolved?
Daily weights: any sudden 2+ lb gain?
Did you see Dr. Patel on 04/02? Any med changes?
Still taking Furosemide, Carvedilol, Metformin?
VitalTrack — BP and weight trending stable?
The Ongoing Monthly Cycle
Every monthQuestionnaire rebuilt from prior month summary + care plan.
Call first, alwaysPhone is primary. Email + SMS only if unanswered.
CoordinatePCP, home health, pharmacy, family, RPM, assisted living — all in the loop.
DocumentEvery interaction recorded, logged, EHR updated if access given.
EscalateAny concern flagged to physician immediately — not held.
Until unenrollmentPatient may stop anytime. Office notified, billing discontinued.

Fully managed.
Zero operational burden.

From patient file to billing package — every step handled, every month, for every enrolled patient.

Enrollment by physician’s office
Monthly calls, emails & texts
Care network coordination
Full documentation & audit trail
Billing package to your team
Let’s Talk

CCM revenue is interesting.
Running it internally isn’t.

If you want to start — or restart — CCM without the operational burden, this is the conversation.

hello@innovosoltech.com

innovosoltech.com