Services
Chronic Care Management
Chronic conditions account for the majority of healthcare utilization and costs, making continuous care essential for both patient health and practice growth.
PMBC’s Chronic Care Management services are designed to help providers:
- Improve patient engagement and long-term outcomes
- Reduce hospital readmissions and emergency visits
- Create predictable monthly revenue streams
- Enhance care coordination without increasing staff burden
With a structured CCM framework, your practice can deliver consistent, high-quality care beyond in-office visits—while we manage the operational complexity.
What is Chronic Care Management?
Chronic Care Management (CCM) is a Medicare-supported program that enables healthcare providers to deliver non-face-to-face care for patients with multiple chronic conditions.
Patients typically qualify if they:
- Have two or more chronic conditions expected to last 12+ months
- Require ongoing monitoring and coordinated care
- Provide consent to participate in CCM services
CCM ensures patients receive continuous support, structured care plans, and access to care teams between visits—leading to improved health outcomes and better quality of life.
Comprehensive Chronic Care Management Services
PMBC delivers end-to-end CCM program management tailored to your practice.
Structured Patient Data Management
We maintain accurate, real-time patient health records, ensuring every care decision is based on complete and up-to-date information.
Personalized Electronic Care Plans
Each patient receives a customized care plan designed to manage their chronic conditions effectively and achieve long-term health goals.
Care Coordination & Transition Support
We handle coordination between providers, specialists, and facilities—ensuring seamless transitions and continuity of care.
24/7 Patient Access & Engagement
Patients gain round-the-clock access to care support, improving adherence, satisfaction, and outcomes.
Dedicated Care Team Support
We assign care coordinators who maintain ongoing communication with patients, strengthening relationships and improving compliance.
Preventive Monitoring & Early Intervention
By proactively tracking patient data, we identify risks early and help prevent complications before they escalate.
Our CCM programs are designed to manage a wide range of chronic illnesses, including:
- Diabetes
- Hypertension
- Cardiovascular disease
- COPD and asthma
- Arthritis
- Depression and behavioral health conditions
- Alzheimer’s and dementia
- Cancer and complex comorbidities
Increased Revenue Opportunities
Generate recurring monthly reimbursements while improving care delivery. Practices can see significant annual revenue growth with structured CCM programs.
Improved Patient Outcomes
Continuous monitoring and engagement lead to better disease control and reduced complications.
Reduced Hospitalizations
Proactive care significantly lowers emergency visits and readmissions.
Enhanced Patient Satisfaction
Patients feel supported with ongoing communication and easy access to care teams.
Streamlined Operations
We manage documentation, compliance, and workflows—so your staff can focus on patient care.
Unlike standalone CCM providers, PMBC integrates Chronic Care Management directly into your Revenue Cycle Management (RCM) and EMR workflows, creating a seamless operational experience.
- AI-driven workflow optimization
- Full compliance with CMS guidelines
- Integrated billing and coding support
- Real-time reporting and performance tracking
- Dedicated account management
This unified approach ensures you not only deliver better care—but also maximize financial performance.
- Patient Eligibility Identification
- Enrollment & Consent Management
- Care Plan Development
- Monthly Monitoring & Engagement
- Documentation & Compliance Tracking
- Billing & Revenue Optimization
We handle the entire lifecycle—so you can scale effortlessly.
Empower your practice with a smarter, scalable care model that improves patient outcomes while increasing revenue. Schedule a FREE consultation with PMBC today and discover how CCM can transform your practice.
Trust Arizona's
Medical Billing and
Coding Specialists
Work with the reliable, knowledgeable team at PMBC.
CCM is a Medicare-supported program that provides ongoing care coordination for patients with multiple chronic conditions.
It improves patient outcomes while generating recurring monthly revenue.
Patients with two or more chronic conditions expected to last at least 12 months.
Yes, we manage documentation, compliance, and billing for CCM services.
No, PMBC handles care coordination and administrative tasks, reducing burden on your team.
