All Four CMS Programs. One Platform. One Workflow.
CCM, RPM, PCM, and RTM -- from enrollment to billing summary. Eligible care work is timed, attributed and documented as it occurs -- helping your billing team capture work that might otherwise go unrecorded.
Care management billing is complex, manual, and often spread across multiple systems. MemberCare unifies all four CMS reimbursable programs in one platform -- streamlining enrollment, time tracking, consultation records, and fee schedules so your team focuses on patients. The platform assembles the documentation; your existing billing workflow submits.
For ACOs and VBC organizations: These same programs drive quality measure performance, close care gaps, and reduce avoidable utilization -- directly impacting shared savings and protecting against downside risk. See our VBC solutions →
Four CMS Programs, One Workflow
Each program includes enrollment workflows, consultation tracking, fee schedule management, and billing documentation support.
Chronic Care Management (CCM)
CPT 99490, 99491
Monthly care coordination for patients with 2+ chronic conditions. Automated time tracking for the required 20+ minutes per month. Care coordination time is documented as it occurs, with monthly billing summaries prepared for your billing team.
Remote Patient Monitoring (RPM)
CPT 99453-99458
Device-based monitoring with monthly billing across the full RPM code set: device setup, data transmission (16+ days/month), clinical review, and interactive communication. Get paid to monitor patients between visits.
Principal Care Management (PCM)
CPT 99424-99427
Focused care management for a single high-complexity condition. Ideal for oncology, neurology, and other specialty patients. Specialized reimbursement for complex patients who don't qualify for CCM.
Remote Therapeutic Monitoring (RTM)
CPT 98975-98981
30-day post-acute monitoring programs for patients after discharge, surgery, or therapy changes. Bridge the gap after discharge with structured monitoring and automated escalation protocols.
From Enrollment to Billing Summary
Every step from enrollment to billing documentation is supported within the platform.
Enrollment Workflows
Patient consent capture, eligibility verification, program qualification checks, and automated enrollment across one or multiple programs simultaneously.
Automated Time Tracking
Every interaction -- calls, messages, care plan reviews, device data review -- is automatically tracked against program time requirements. No manual timers or spreadsheets.
CPT Code Support
Monthly billing summaries with suggested CPT codes, units, and modifiers assembled from documented time and services -- supporting documentation for your existing billing workflow. Fee schedule management across payers.
Consultation Records
Structured documentation for every patient interaction that creates audit-supporting documentation. AI-drafted conversation summaries, ready for your team's review, reduce documentation burden.
EDI Claims Processing
Standards-based electronic claim submission with built-in validation checks. Remittance processing and denial tracking help reduce revenue leakage.
Prior Authorization AI
AI-drafted prior authorization letters for your team's review and submission. Drug-specific PA requirements, payer rules, denial appeal support, and status tracking to help reduce authorization delays.
Built for Billing Integrity
Frequently Asked Questions
Common questions about CMS care management programs, billing documentation, and revenue.
Request a Revenue Analysis
See how MemberCare helps your billing team capture work that might otherwise go unrecorded.
Or call us: 214.226.5319