Build CCM Software that Works for You— Not Against You

Custom CCM software centralizes care plans, time tracking, patient communication, vitals, and follow-ups for Medicare patients with two or more chronic conditions. A custom-built platform lets clinics tailor workflows, automate required documentation, ensure CMS-compliant processes, and deliver proactive, coordinated care for high-risk patients without relying on rigid, off-the-shelf systems.

A custom CCM platform should automate time capture, support electronic care plans, record non-face-to-face activities, and map minutes to appropriate codes. It must distinguish between regular and complex CCM, manage add-on minutes, prevent double-counting, and generate audit-ready logs. Built-in compliance rules ensure every claim meets CMS documentation and supervision requirements.

Yes, custom software can digitize consent collection, store it in the patient record, verify eligibility, and track consent status automatically. It ensures compliance with CMS requirements by documenting patient understanding of cost-sharing, program details, and the right to discontinue. Automated workflows eliminate manual paperwork and prevent enrollment or billing errors.

Custom CCM software logs time automatically as staff complete calls, assessments, care-plan updates, coordination tasks, and messaging. Each action is time-stamped and linked to the patient’s record. The system aggregates minutes, prevents overlap with other programs, and generates monthly billing summaries, ensuring accurate, CMS-compliant documentation without manual spreadsheet tracking.

Custom software can separate regular and complex CCM workflows by tracking required time thresholds, medical decision-making complexity, care-plan elements, and add-on minutes. It can guide staff through the correct documentation, flag when a patient qualifies for complex CCM, and ensure billing codes match clinical complexity, simplifying compliance and reimbursement accuracy.

Yes, a custom platform can track CCM and RPM activities separately, ensuring minutes aren’t double-counted and each program meets CMS criteria. Automated logic can assign tasks to the correct service, synchronize device data, and generate clean billing reports. This allows clinics to run both programs efficiently while maintaining full compliance.

Custom CCM software integrates via FHIR or APIs to sync notes, care plans, vitals, assessments, and outreach activity directly into the EHR. Bi-directional syncing ensures providers' charts are updated once, and data appears everywhere it’s needed. This eliminates duplicate work, keeps records aligned, and simplifies billing, documentation, and care-coordination workflows across systems.

Custom CCM software can automatically record time spent on medication reviews, symptom checks, care-plan updates, coordination with specialists, patient or caregiver communication, vitals review, and education. These non-face-to-face activities count toward CCM billing. The system excludes ineligible tasks and creates CMS-ready logs to ensure accurate, compliant billing.

Custom CCM software enables continuous patient monitoring, timely follow-ups, automated reminders, medication adherence tracking, and early detection of worsening symptoms. By surfacing risk alerts and coordinating care quickly, clinics can intervene before issues escalate. This proactive oversight reduces avoidable ED visits, stabilizes chronic conditions, and improves long-term patient outcomes.

Physicians, NPs, PAs, CNSs, and CNMs can bill CCM while clinical staff deliver services under proper supervision. Custom software ensures compliance by maintaining electronic care plans, logging staff activities, validating supervision requirements, and preventing billing conflicts. Automated audit trails help clinics meet CMS documentation standards with far less administrative burden.