Get Paid for the Chronic Care Management You Perform.
A pharmacy-delivered Chronic Care Management program built on GenieMD's clinical oversight, RxHealing's enrollment engine, and your relationship with your patients.
Three Time-Based Levels of Care Management
Every patient's care is billed at the tier that reflects the qualifying CCM time actually furnished that month.
Enrollment & Consent
Our team explains the program and obtains informed, voluntary consent from eligible patients. Enrollment is optional, with no payment for enrollment.
Actively Managed Care
Our expected average for an actively managed patient — an estimate only, not a guarantee of billable time or reimbursement.
Complex Care Management
Patients with medically complex conditions who require more intensive, practitioner-directed care management.
A Fixed Fee, Paid for Care Actually Performed
A fixed fee per patient, per month, representing fair market value for bona fide, documented, medically necessary care management services actually performed.
Paid for medical necessity, not for volume
The fee is set in advance, consistent with fair market value, and identical for every pharmacy in the network. It is not a percentage of Medicare reimbursement or a per-enrollment payment, and is not based on the volume or value of referrals or other business between the parties. The pharmacy is compensated only for calendar months in which all applicable CCM requirements are met.
The Clinical Work
Documented, practitioner-directed activities that make up qualifying CCM time — separate and distinct from dispensing.
Barrier Resolution
Resolve medically necessary barriers to the care plan, such as prior authorizations and therapeutic alternatives. Dispensing activities are not CCM time.
Care Plan Updates
Update the patient's comprehensive care plan, under the direction of the billing practitioner, based on response to therapy and changes in health status.
Medication Reconciliation
Reconcile medications across prescribers and fills, including OTC products and supplements. This care-management activity is separate from dispensing.
Care Coordination
Communicate with providers and other team members to align care and avoid gaps.
Adherence Coaching
Assess and address barriers to medication adherence, such as cost, side effects, understanding, or transportation, as part of the practitioner-directed care plan.
Transitions of Care
Support patients after hospital or ED visits to prevent readmissions and complications.
How the CCM Program Works
From identifying an eligible patient to getting paid — five steps, all supported by GenieMD's clinical oversight and RxHealing's enrollment engine.
Patient Appears in the Portal
You identify patients who may qualify for CCM based on two or more chronic conditions expected to last at least 12 months, and offer enrollment under the billing practitioner's direction.
Perform Care Management
You perform documented, practitioner-directed care management activities that are medically necessary.
You Reach the Patient Your Way
You communicate with the patient by phone (or video, text, in-person) using your own systems.
Time and Notes Are Reported
You document the activity and report the time in the portal.
Initiating Visit & Care Plan
Offer enrollment to eligible patients under the billing practitioner's direction. Complete the initiating visit, obtain informed consent, establish a care plan, and provide 24/7 access to care.
Documentation Requirements & Key Principles
Documentation Requirements
Document care management activities and time spent in the patient's medical record.
- Time is counted cumulatively for qualifying CCM services furnished during the calendar month; no minimum time increment is required.
- Reflect the correct time tier (20, 40, or 60 minutes) based on qualifying CCM services furnished that month.
- Activities must meet the CCM requirements to be counted.
Key Principles
CCM time must be:
- Actual time spent on care management activities for the patient.
- Directed by the billing practitioner.
- Medically necessary.
- Not duplicative of dispensing activities or services already reimbursed under another arrangement.
Join the CCM Program
Start getting paid for the chronic care management your pharmacy already performs — built on GenieMD's clinical oversight and RxHealing's enrollment engine.
Join the CCM Program