All Four CMS Programs. One Platform. Automated Billing.
CCM, RPM, PCM, and RTM -- from enrollment to reimbursement. Automated time tracking, CPT code generation, and monthly billing summaries so you capture every dollar you've earned.
Most organizations leave money on the table because care management billing is complex, manual, and spread across multiple systems. MemberCare unifies all four CMS reimbursable programs in one platform -- automating enrollment, time tracking, consultation records, fee schedules, and claim submission so your team focuses on patients while the platform handles revenue capture.
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, Fully Automated
Each program includes enrollment workflows, consultation tracking, fee schedule management, and CPT code automation.
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. Turn care coordination into recurring revenue with automated billing summaries and claim generation.
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 Reimbursement
Every step in the revenue cycle is automated within the platform.
Enrollment Workflows
Patient consent capture, eligibility verification (P-Verify/Benzer integration), 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 Automation
Monthly billing summaries with the correct CPT codes, units, and modifiers generated automatically based on documented time and services. Fee schedule management across payers.
Consultation Records
Structured documentation for every patient interaction that satisfies CMS audit requirements. AI-powered conversation summaries reduce documentation burden.
EDI Claims Processing
T837 professional claim submission with a built-in business rule engine for claim validation. Remittance processing and denial tracking to minimize revenue leakage.
Prior Authorization AI
AI-powered prior authorization letter generation. Drug-specific PA requirements, payer rules, denial appeals, and automated status tracking to eliminate authorization delays.
The Revenue Opportunity
Frequently Asked Questions
Common questions about CMS care management programs, billing automation, and revenue.
Calculate Your CCM Revenue
See how much revenue your organization is leaving on the table and how MemberCare can help you capture it.
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