Achieve the goals of Triple Aim

Enhance patient experience
Lower healthcare costs
Improve health outcomes

At DrCatalyst, we act as an extension of your team.

We treat your patients like we treat our patients. DrCatalyst's CCM program fills the gap between office visits with one-on-one, personalized interactions to help patients better manage their conditions

Maximize Incentives

CMS places significant weight on CCM for your MIPS score. With DrCatalyst’s CCM program, our experts will help you succeed with CCM so you can achieve optimal and consistent MACRA compliance—which means maximum incentives and zero penalties.

Generate More Income

Under the CCM program authorized by CMS, you can bill $43 - $142 per month, per Medicare patient with two or more chronic conditions who receive at least 20 minutes of chronic care activity associated with non-face-to-face care coordination services.

Automate Your Workflow

No need to disrupt your current processes. You’ll receive ready-made documentation and regular reports that allow you to easily bill for chronic care services. Your patients also receive regular check-in calls to monitor their health, satisfaction, and engagement.

Benefits for the Providers

Improve Patient Outcomes
Increase Practice Revenue
Improve your MACRA/MIPS Scorecard
Decrease Administrative Workloads
Enhance Patient Satisfaction

Benefits for the Patients

24/7 Access to Healthcare Support
Personalize Care Plans
Lower Healthcare Expenses
Support to Reinforce Healthy Habits
More Engagement = Better Outcomes

Chronic disease is a formidable foe.

One of the primary reasons CCM is so important is that it helps all stake holders in healthcare — patients, physicians, and payers — deal with the serious and costly problem of chronic disease.

What is required for CCM?

Detailed list of requirements from CMS

2 or more chronic conditions Must use a certified EHR Technology 24/7 access to care management services
Serious health risk or at risk of death 20 minutes per patient per month Comprehensive patient-centered care plan
Must consent to the CCM Service Documented time spent per patient Care plan available 24/7 to entire staff
May have a co-pay Monthly reports and summary of CCM Care plan shared with EMR and other providers

Chronic Care Staffing closes the gaps in care for your patients and opens the door to additional revenue for you.

A comprehensive set of chronic care management services:

Increased Patient Education / Awareness
Identifying Patients in Need of Their Annual Wellness Visit (AWV)
Assisting with Medication Refills / Reconciliation
Assisting with Verbal Enrollment Maximizing CCM Patient Participation
Documenting and Reporting Change in Patient Health Status
Referral Coordination
Transition of Care Notice to Provider

Exciting news about CCM Expansion

Medicare Advantage, Medicaid, and Commercial payers are actively entering the market.
Remote enrollment is now allowed
New code 99487, 99489, and G0506 are now available for CCM
CCM is now available for RHC and FQHC Practices

Why choose DrCatalyst for your CCM services?


Patient Qualification

Do you have Medicare beneficiaries with two or more chronic conditions expected to last the next 12 months? Our trained remote staff will identify patients from your EHR who are eligible to participate in the Chronic Care Management program.

Healthcare partners in your area can assist you in sorting out a list of patients who are eligible for CCM services.


Patient Outreach

We will reach out to your eligible CCM patients on your behalf to educate them about the benefits of the program, how it works, and, if necessary, provide assistance on scheduling their next office visit to obtain enrollment consent.


Staff Training

To ensure a successful CCM program launch for your practice and help you furnish a successful CCM service, we train your staff on the overall program, how to identify eligible CCM patients, and how to engage your current patients.


1-on-1 Patient Engagement

Our trained staff will engage with your qualified patients for at least 20 minutes every month to review their care plan and progress toward the patient’s individual healthcare goals. Rest assured our team serves as an extension of your practice with the promise of delivering the same high quality patient engagement you and your staff adhere to!


Comprehensive Care Plan Development

Through a comprehensive assessment of the patient’s medical, functional, and psychosocial needs, our trained staff will create a comprehensive care plan for each patient. It serves as a road map for patients to follow and track their progress.


Management and Monitoring CCM Patients Care

We provide a fluid digital care plan you can utilize at all points of care. The comprehensive care plan for each patient is created, established, implemented, revised and monitored throughout the program. It is an easy way for providers to track the patient and their progress.



Our remote staff will document all CCM activities directly in the patient’s medical record (Beneficiary Consent, detailed account of the non-face-to-face services provided, and the Comprehensive Care Plan) required by Medicare.


Reports Auditing

Don’t miss out on lost revenue. With CCM, you can only bill in months with activity, so it is critical to ensure proper reporting. Our staff provides an auditable report at the end of each month so you can easily bill the 99490 and other codes for your CCM patients.


24/7 Availability

Due to its non-face-to-face nature of patient care, it is vital in the CCM program to provide a 24/7 care management access for patients. In addition to a patient portal where patients can view health information such as recent doctor visits and medications, DrCatalyst's CCM program offers patients 24/7 telephone service.

DrCatalyst's CCM Process

  • Week 1
    Verify EMR Compliance
    Draft Implementation
    Agree on Scope
    Draft Agreement
  • Week 2
    Workflow Analysis
    Hold Workflow Analysis
    Provide Patient Materials
    Analyze Patient Data
    Create Opportunity List
    Obtain RN EMR Access
    Train RN on EMR
    Finalize Workflow
  • Week 3
    Patient Enrollment
    Contact Patients Not Enrolled
    Obtain Patient Consent
    Create Care Plans
    Document all Information in EMR
  • Week 4
    Care Management
    Document all Information in EMR
    Manage Transitions
    Monthly 20-minute Follow-up
    Monthly Billing Reports
    Send Monthly Summary

Frequently Asked Questions

Chronic Care Management services require a minimum of 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month with the following required elements:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
  • Comprehensive care plan established, implemented, revised, or monitored

If they are Medicare Part B patients with no secondary coverage, yes. It will cost them $8/month.

If they have a supplemental coverage, there is no additional cost.

DrCatalyst’s CCM service provides your CCM patients with 24-hour-a-day, 7-day-a-week (24/7) telephone access to our qualified clinical staff. This provides your patients with the means to make contact with a healthcare professional any time or day of the week.

Patients will also have 24/7 access to an online patient portal where they can view their care plan, medications, and communicate through secure and direct messaging with their physician.

Absolutely. CMS permits clinical staff to provide CCM services “incident to” the services of the billing physician (or appropriate practitioner). This allows our licensed clinical staff to provide CCM services on your behalf rather than under the direct supervision of a physician.

For new patients or patients not seen within one year prior to the start of CCM, Medicare requires the initiation of CCM services during a face-to-face visit with the billing provider: Annual Wellness Visit (AWV), Initial Preventive Physical Examination (IPPE), or Evaluation and Management Visit (E/M).

Our remote staff will reach out to your qualified patients to schedule a monthly 20-minute call where we discuss their healthcare goals. During the call we talk through their progress and ensure that they are complying to the medications, diet, and routine exercises as prescribed by their doctors based on their individual care plan.

  • Physicians (of any specialty)
  • Licensed Clinical Staff Members
    • Advanced Practice Registered Nurses
    • Physician Assistants
    • Registered Nurses
    • Licensed Clinical Social Workers
    • Licensed Practical Nurses
    • Clinical Nurse Specialists
    • Clinical Pharmacists
    • Certified Medical Assistants

Per CMS, only one provider can bill a CCM service per patient per month.

  • Certain ESRD codes 90951-90970
  • Home Healthcare Supervision code G0181
  • Hospice Care Supervision code G0182
  • Transitional Care Management codes 99495 and 99496

DrCatalyst is a trusted and proven remote staffing partner. Our entire model is based on our staff of dedicated healthcare professionals working as an extension of your team. You can rest assured your patients will receive the supplemental care they need and you’ll receive peace of mind with detailed reporting and documentation to back it up!

Yes. Our remote staff team goes through thorough HIPAA-compliance training and are required to maintain compliance with HIPAA training refresher courses every year.

Revenue Calculator

Use the calculator below to calculate your estimated CCM revenue.

Your Estimated Annual Gross Revenue for CCM


Ready to Succeed in CCM?

Let's get started! Find the plan that's right for your practice and your patients.

IN-House Payment


one time fee

$3.50 per billed patient per month

  • IMS CCM Module and Setup Procedure
  • Consulting Available
  • Long-Term Access for CCM Queries for 2018-2019



  • Dedicated Nurse / MA
  • IMS CCM Module and Setup
  • Patient Consent Signature
  • Dedicated Care Manager
  • 24 x 7 Coverage
  • Care Plan Creation and Monthly Revision
  • Disease-Based Protocols
  • Complete Billing Cycle Management
  • Improved Practice Appointments
  • Monthly Performance Reports
  • Online Portal Management

Get Started with CCM