Solutions
Solutions
Chronic Care Management
Med-IT has helped practices launch and sustain Chronic Care Management programs that improve outcomes for patients with two or more chronic conditions — and generate recurring revenue while doing it.
Our platform works as an extension of your clinic: personalized care plans, medication reconciliation, monthly contact and documentation that supports Medicare CCM requirements.
Why it works
Health coaches build individualized care plans around each patient's conditions, goals and daily reality.
Patients get a consistent point of contact between visits, with phone and secure digital messaging options.
Structured reconciliation surfaces duplicates, interactions and adherence gaps before they become problems.
Time tracking and audit-ready documentation keep monthly requirements in order.
Every engagement is scoped to your practice, but the core program looks like this:
Eligibility review and program enrollment
Interdisciplinary, patient-centered care plan
Monthly care coordination contact
Medication reconciliation
Goal setting and progress tracking
Care team communication tools
Documentation and time tracking
Program performance reporting
Sub-services
Each part can run inside the program or be added on its own — the same team and the same record either way.
An interdisciplinary, patient-centered plan with measurable goals.
A scheduled monthly contact with the same care manager each time.
Duplicates, interactions and adherence gaps reviewed every cycle.
Time tracking and audit-ready records behind each billed month.
How it works
The same five-stage model runs behind every program — visible in the platform and documented for billing.
We review your panel for eligible patients and map current workflows before launch.
Each patient receives a structured care plan with measurable goals and a contact schedule.
Coaches deliver monthly touchpoints by phone and app, escalating clinical concerns quickly.
Every encounter is recorded with time and outcomes, ready for review and billing.
Billing
Med-IT documents the encounters and time requirements these codes depend on. Eligibility always depends on the patient and payer.
Billing rules and coverage change. Confirm current requirements with CMS and your payer before submitting claims.
Patient experience
Programs are designed for long-term participation — not a one-time device drop.
A dedicated care manager who knows their history
Help coordinating appointments, refills and referrals
A care plan they helped build
Encrypted messaging with the care team
FAQ
Still deciding? Ask us anything specific to your specialty or payer mix.
Medicare patients with two or more chronic conditions expected to last at least 12 months — or until death — that place them at significant risk of decline. Our team reviews eligibility with you before enrollment.
No. You can use Med-IT's clinical teams as a full-service extension, run the program internally on our platform, or blend both.
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Get started
We will walk through your panel, the workflow and the billing requirements — then show the platform with your scenario.