Frequently Asked Questions - CCM
FAQs – Chronic Care Management
We’ve provided a categorized list of the most frequently asked questions we get from patients and providers alongside their answers.
To see the frequently asked questions for each category, simply click on the button for each category below,
Health Nexus helps practices identify patients who may be eligible for CCM based on chronic condition profile, provider relationship, and program requirements. CCM is generally appropriate for established patients managing two or more chronic conditions that are expected to last at least 12 months. Patients should not be enrolled in another CCM program at the same time, and nursing home patients may qualify when requirements are met.
Many patients have no out-of-pocket cost for CCM. When a copay or coinsurance may apply, Health Nexus contacts the patient with an estimate and obtains approval before final enrollment. This helps create transparency, avoids billing surprises, and supports a smoother patient enrollment process.
Patients can only be enrolled in one CCM program at a time. However, eligible CCM patients may also participate in RPM or RTM through Health Nexus when clinically appropriate. These programs are billed separately using different CPT codes and can work together to support patients with complex or comorbid conditions. The key compliance rule is that time and services cannot be double-counted across programs.
Very! Patient engagement is very important. Health Nexus’s clinical monitoring team becomes a trusted coach for enrolled patients, helping them stay connected to their care plan between visits. We communicate through the patient’s preferred channel, including phone, text, in-app messaging, and telehealth, making the program convenient, personal, and easy to adopt.
There is no provider obligation. Health Nexus also sends a monthly report directly to your EMR.
The provider submits the reimbursement claim and receives payment directly. Health Nexus supplies monthly summary reports to support billing, and most practices use those reports to bill internally. For groups that want additional help, Health Nexus can provide full revenue cycle support upon request.
Medicare and most private insurance companies cover CCM.
CCM is not encounter-based. Health Nexus can provide the required patient monitoring, engagement, and care coordination support, so your office staff does not need to personally contact every enrolled patient each month in order to bill, as long as program requirements are met and documented.
Patient data security is a top priority. Health Nexus is HIPAA-compliant and follows applicable privacy and security rules for protecting patient health information. Providers can feel confident that patient data is handled securely and responsibly throughout the program.
Health Nexus can launch your program in about two weeks. Our onboarding process is simple and efficient, typically requiring only 2–3 hours of staff education time. This allows your practice to begin offering CCM quickly without a major operational lift.
Patient referrals are simple and fast. With EMR integration, referrals can be completed in just a few clicks. Through the Health Nexus platform, referrals typically take about one minute. Health Nexus then verifies insurance, and most patients can begin the program within 24–48 hours.
Health Nexus is built for scale. Our platform can manage high volumes of patient data and program activity, allowing your practice to enroll all eligible and consenting patients smoothly as the program grows.