(636) 634-1229 info@onpointrcm.com 201 Clarkson Executive Park, Ellisville, MOMon–Fri, 8am–6pm CT
Revenue program · qualifying Medicare patients only

Chronic Care Management, run by us, billed by you.

Nearly seven in ten of your Medicare patients qualify. Fewer than one in twenty-five is enrolled anywhere. CCM pays your practice every month a qualifying patient gets the care coordination they should already be getting — and the reason most practices skip it is staffing, not eligibility.

Your clinical directionDocumented in your EMR24/7 nurse line

The gap this program closes

Eligible Medicare patients vs. patients actually enrolled anywhere.

69% eligible · under 4% enrolled69%eligible
69% qualifyMedicare patients with two or more chronic conditions
Under 4% enrolledEligible patients receiving CCM anywhere

Sources: CMS, 2017 · Avalere Health, 2019

The economics

What the program is worth to a practice

An illustration, not a quote. Give us your own patient numbers and we will model it against your locality’s fee schedule.

Illustrative annual reimbursement

Example figures
Medicare patients you see
1,000
Likely eligible (69%)
690
Enrolled at a 30% consent rate
207
Annually, at ~$62 × 12 months
~$154,000
Eligibility share from CMS (2017). The per-patient figure is an approximate national Medicare average for the base 20-minute service, rounded; locality adjustment, payer mix and complex-tier patients all move it. Consent rate shown is an assumption for the illustration, not a promise — your real number depends on your patients and how the conversation is run. The annual figure assumes every enrolled patient hits the time threshold in all twelve months; in practice some months fall short, and only months with documented time are ever billed. Nothing here is a guarantee of revenue.
Who qualifies

Not every patient — three conditions, checked first

Patients who fail any one of these are never enrolled, and never appear on a claim.

Two or more chronic conditionsExpected to last at least 12 months, or until the end of life, and placing the patient at significant risk of decline.
An initiating visit on fileRequired for new patients and anyone not seen in the last 12 months. An annual wellness visit, a Welcome to Medicare visit or a comprehensive E/M all count.
Patient consentVerbal or written, with cost-share explained and documented in the chart.
What the patient gets

Every calendar month, without exception

The care plan is a live document in your EMR, not a PDF nobody opens.

The monthly touch

  • A coordinator call — the same person each month, who knows the chart
  • Medication reconciliation — what they are actually taking versus what is prescribed
  • Care gap closure — overdue labs, screenings and follow-ups chased
  • Social barriers — transport, cost, food and caregiver issues assessed and logged
  • 24/7 nurse line — a number to call that is not the emergency room

What is in the care plan

  • Problem list and the patient’s own health goals
  • Current medications and who prescribed them
  • Every other provider involved in their care
  • What care is needed next, and who is doing it
  • Shared with the patient, and visible to your team in the EMR
Division of labor

What we do, and what stays with you

OnPoint RCM does

  • Pulls the eligible list out of your EMR
  • Calls patients, explains cost-share, captures consent
  • Builds and maintains the care plan
  • Makes the monthly contact and documents it
  • Coordinates with the other providers involved
  • Logs the minutes and flags the month as billable
  • Staffs the 24/7 nurse line

Your practice keeps

  • Clinical direction — our staff work under your providers
  • The patient relationship, in your practice’s name
  • The billing — the claim goes out under your NPI
  • EMR access and the final say on the care plan
  • Physician oversight of escalations
How it runs

The month, start to finish

The billable event is time, so the log is built as the work happens rather than reconstructed at month end.

Chronic Care Management

Monthly cycle
Step 1Eligibility sweepYour patient list filtered for 2+ chronic conditions and an initiating visit on file.
Step 2Consent & enrollmentCost-share explained, consent captured and documented.
Step 3Care plan builtProblems, meds, goals and social needs, in a plan the patient receives.
Step 4Monthly outreachCoordinator call, med reconciliation, gap closure, nurse line behind it.
Step 5Time loggedMinutes captured per contact; thresholds flagged automatically.
BillingMonth billedThreshold met and documented. Cycle restarts on the 1st.
Patients who miss two consecutive months move to a re-engagement queue before they are dropped from the program.
Questions we get

Before you ask

Can it be billed alongside other services?

It is billable once per patient per calendar month, and cannot be billed in the same month as transitional care management or home health supervision for that patient. We track the conflicts so the claim does not bounce.

Does the patient pay anything?

Standard Medicare cost-sharing applies unless the patient has supplemental coverage. We explain it plainly during the consent call — patients who are surprised by a bill do not stay enrolled.

Who are the people making the calls?

A dedicated care coordinator assigned to your practice, working under your providers’ direction, with an implementation manager and a quality manager behind them.

What happens to patients who do not answer?

They enter a structured re-engagement sequence. If two consecutive months pass with no qualifying contact, we tell you before anyone is dropped — and no month goes on a claim without documented time behind it.

See what your practice is leaving on the table

A 30-minute call. Tell us roughly how many Medicare patients you see, which EMR you use and what you already run in-house. We come back with which programs your patients qualify for, what each one would take to run, and what it is likely to be worth.

(636) 634-1229Mon–Fri, 8am–6pm CT
info@onpointrcm.comWe reply the same business day
201 Clarkson Executive ParkEllisville, MO 63011

Request a practice review

Same-day reply. Nothing is billed and no patient is enrolled from this form — it starts a conversation, nothing more.

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