Start a Chronic Care Management (CCM) Service for Medical Practices

1. 1

   Learn the billing rules cold

   Medicare's chronic care management codes pay practices a monthly per-patient fee (commonly in the range of $60 or more per patient per month across the code family) for at least 20 minutes of documented non-face-to-face care coordination for patients with two or more chronic conditions. The service must be furnished under the billing practitioner's supervision by clinical staff, with patient consent, a care plan, and auditable time logs. Read the current CMS rules yourself; they change yearly and your whole business is compliance with them.

2. 2

   Set up HIPAA-grade operations

   You will handle protected health information daily, so you need business associate agreements with every practice, encrypted systems, access controls, and written privacy procedures before the first patient call. A CCM-specific software platform (several exist) handles enrollment, time tracking, and billing reports far better than spreadsheets.

3. 3

   Staff the clinical side honestly

   The calling work is done by clinical staff (RNs, LPNs, or medical assistants depending on state supervision rules) operating under each practice's billing provider. Retired and part-time nurses are an excellent workforce here because the work is phones and care plans from home on flexible hours. A non-clinical founder can own and run the company while employing the clinical callers.

4. 4

   Price as a revenue share

   The standard pitch is that the practice bills Medicare and pays you a per-patient monthly rate or percentage that leaves them clear profit for work they were not doing anyway. Model your labor cost per patient per month (calls, documentation, care plan updates) and keep your rate under what the practice collects, or nobody signs.

5. 5

   Land the first two practices

   Target independent primary care and internal medicine practices with heavy Medicare panels; the owner-physician feels the missed revenue personally. Offer a 90-day pilot on one panel segment with clear enrollment, documentation, and revenue reporting. One well-run pilot converts, and practice managers talk to each other.

6. 6

   Layer adjacent programs on the same engine

   The identical infrastructure (enrollment, monthly clinical touches, time logging) also runs remote patient monitoring support, behavioral health integration codes, transitional care management after discharge, and annual wellness visit prep. A full chronic disease management clinic model, with intensive coaching and monitoring under one roof, is where some operators eventually take this, but the outsourced service is the low-capital way in.

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