Take Control of Your Time, Simplify Care, and Enhance Savings.

You know the frustration – drowning in administrative tasks that steal time away from what matters most: caring for your patients. Well, Gen By Gen is here to provide you comprehensive support in keeping you engaged with your patients for better outcomes.

With our CCM-RPM services, you can effortlessly manage patients with chronic conditions, engage patients, and drive better results while adding revenue to your practice- without adding more hours to your day.

%

Adult Americans have a chronic condition

%

Americans have a 2+ chronic condition

%

Medicare spending is on patients with chronic diseases

%

Americans die from chronic diseases

  • Hypertension 48.1% 48.1%
  • Chronic Pain 20.9% 20.9%
  • Depression 18.5% 18.5%
  • Diabetes 11.6% 11.6%
  • Asthma 8.7% 8.7%

Medicare benefit payments totaled $597 billion in 2014

2/3rd of Medicare beneficiaries have 2+ chronic conditions

Annual per capita Medicare spending increases with beneficiaries’ number of chronic conditions

People with chronic conditions account for 86% of national healthcare spending

The above stats show that chronic care management is the need of the hour, not just from the perspective of value-based healthcare but also due to the rising number of people with chronic conditions.

Chronic Care Management(CCM)

The Medicare Chronic Care Management (CCM) program is a service designed to provide additional support and coordination for Medicare beneficiaries with two or more chronic conditions. It allows eligible healthcare providers to bill Medicare for non-face-to-face care management services offered to these patients.

Remote Patient Monitoring (RPM)

Telehealth has made it possible to keep a close eye on patients’ health from the convenience of their homes. Remote patient monitoring is a game-changer for managing various health conditions, and it also saves patients time, and money, and reduces their risk of exposure to hospital-borne infections.

How it Works?

Gen By Gen delivers successful and customizable Chronic Care Management (CCM) services by following these 6 simple steps.

Get in touch with us to secure your consultation

A Financially Sustainable Solution

Estimate your Annual RPM/CCM Revenue

Physicians can earn $200,000+ per year through Remote Patient Monitoring (RPM) and Chronic Care Management (CCM)

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Step 1

Receive Billing Reports

We provide your practice the billing reports and summaries, including RPM/CCM CPT codes based on patient’s vitals data and clinical service time.

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Step 2

Submit Claims

The clinic submits claims to insurance based on monthly billing reports.

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Step 3

Get Reimbursed

The clinic receives optimal reimbursement based on the codes submitted.

Frequently Asked Questions

Who is eligible for Chronic Care Management (CCM)?

Chronic Care Management (CCM) is a program offered by the Centers for Medicare & Medicaid Services (CMS) and is available to patients who have Medicare Part B coverage and have at least two or more chronic conditions. The chronic conditions that qualify for CCM services are those that have been or are likely to last at least 12 months and require frequent medical attention and self-management. Examples of chronic conditions that qualify for CCM services include:

CCM services include:

  1. Diabetes
  2. Heart failure
  3. Coronary artery disease
  4. Chronic obstructive pulmonary disease (COPD)
  5. Hypertension
  6. Cancer
  7. Depression and other mental health conditions
  8. Asthma
  9. Chronic kidney disease
  10. Arthritis
  11. Osteoporosis
  12. Alzheimer’s disease
  13. Parkinson’s disease

To be eligible for CCM services, patients must also be seen by a primary care provider or a care manager at least once every 90 days and have a care plan established with the patient or their caregiver.

It is important to note that this program is only for patients with

Medicare Part B coverage, those who have Medicare Advantage plans (Medicare Part C) are not eligible for this program. Additionally, the patient should not be in an inpatient setting, hospice, or receiving home health services. If a patient is in an inpatient setting, then other programs such as Transitional Care Management (TCM) are more appropriate.

What are the applicable reimbursements for CCM in 2024?

2024 CCM Reimbursement Rates
99490 The first 20 minutes of clinical chronic care management services for patients with two or more chronic conditions expected to last 12+ months. $62*
99439 Each additional 20 minutes of clinical time directed by a healthcare professional for chronic care management services. $47*
99491 At least 30 minutes of chronic care management services, delivered by the billing provider, for patients with two or more chronic conditions expected to last 12+ months. $83*
Complex CCM
99487 The first 60 minutes of complex chronic care management services for patients with moderate to complex conditions. $132*
99489 Each additional 20 minutes of complex chronic care management services for patients with moderate to complex conditions. $71*
*actual reimbursement varies by region.

What are the applicable CPT codes for CCM?

There are several Current Procedural Terminology (CPT) codes that are used to bill for chronic care management (CCM) services in the United States.

  1. 99490- This code is used for at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.
  2. 99487 – This code is used for the initial assessment and care planning for patients with multiple (two or more) chronic conditions that are expected to last at least 12 months, or until the death of the patient.
  3. 99489 – This code is used for the ongoing care management of patients with multiple (two or more) chronic conditions that are expected to last at least 12 months, or until the death of the patient.
  4. G0506 – This code is used for remote evaluation of recorded video and/or images furnished to the patient/caregiver.
  5. 99458, 99459 – These codes are used for remote evaluation of patient-transmitted recorded video or image by a physician or other qualified healthcare professional via telephone, internet, or e-mail.

It is important to note that the codes and reimbursement for CCM services may vary depending on the payer, so it’s best to check with your local Medicare administrative contractor or your private payer for more information.

Who is eligible for RPM?

The Remote Patient Monitoring (RPM) program is an add-on service to the Chronic Care Management (CCM) program and is available to Medicare beneficiaries who are also enrolled in the CCM program. To be eligible for RPM services, patients must meet the following criteria:

  1. They must have Medicare Part B coverage.
  2. They must have at least two or more chronic conditions that have been or are likely to last at least 12 months and require frequent medical attention and self-management.
  3. They must be seen by a primary care provider or a care manager at least once every 90 days and have a care plan established with the patient or their caregiver.
  4. They must be willing and able to use the devices and technology required for RPM, such as blood pressure monitors, glucose monitors, weight scales, pulse oximeters, activity trackers, medication management devices, telehealth devices, and wearable devices.
  5. They must not be in an inpatient setting, hospice, or receiving home health services.

It’s important to note that to bill for RPM services, the provider must meet certain requirements set by CMS such as:

Care coordination needs to be performed with other providers of the patient.

Care needs to be provided at least 20 minutes of non-face-to-face care management services each calendar month, including care coordination and communication with other providers.

RPM services can be provided by physicians, nurse practitioners, physician assistants, nurses, and care managers.

What are the applicable CPT codes for RPM?

The applicable Current Procedural Terminology (CPT) codes for Remote Patient Monitoring (RPM) services in the United States are:

  1. 99457 – This code is used for the provision of medical evaluation and management services furnished to a patient by a physician or other clinician who is not part of the patient’s care team, using communication technology (e.g., interactive audio and video) for the evaluation and management of the patient’s health status.
  2. 99458 – This code is used for the provision of medical evaluation and management services furnished to a patient by a physician or other clinician who is part of the patient’s care team, using communication technology (e.g., interactive audio and video) for the evaluation and management of the patient’s health status.
  3. R99457 and 99458 – Can be used to bill for RPM services when the provider performs 20 or more minutes of care management services each calendar month, including care coordination and communication with other providers.
  4. 99457 and 99458 – Can be used in combination with codes for the collection of patient data (e.g., vital signs, weight, and oxygen saturation), management of patient-generated data, and other medical decision-making services related to the care of the patient.

It is important to note that billing for RPM services requires a high level of documentation and requires providers to meet certain requirements set by CMS. Additionally, the codes and their use may vary depending on the type of RPM services being provided and the payer policy. It is recommended that healthcare providers consult with a billing specialist for more information on coding and billing for RPM services.

What Our Clients Say About Our Service?

Partnering up with Gen By Gen has completely transformed our business. Their comprehensive care management services have assisted us in making our operations more efficient, decreasing administrative tasks, and enhancing patient results.

Kaytlin Housten, MSN

Nursing Director - CCM Client