Get paid for the chronic care you already perform.
A pharmacy-delivered chronic care management (CCM) program built on GenieMD’s clinical oversight, RxHealing’s enrollment engine and the relationships you already have with your patients.
Time-based, month by month.
Each patient’s care is billed at the level that matches the qualifying CCM time furnished that calendar month.
Enrollment & consent
The team explains the program and obtains informed, voluntary consent. Enrollment is optional, and there is no payment for enrollment.
Actively managed care
An expected average for an actively managed patient. It’s an estimate only, not a guarantee of billable time or reimbursement.
Complex care management
For medically complex patients who need more intensive, practitioner-directed management.
What GenieMD pays your pharmacy
A fixed fee, paid for care actually performed.
A fixed monthly fee per patient, set as fair market value for documented, medically necessary care management actually performed.
Paid for medical necessity, not volume. The fee is set in advance and is the same for every network pharmacy. It isn’t a percentage of Medicare reimbursement, a per-enrollment payment, or based on the volume or value of referrals. It’s paid only for months in which all CCM requirements are met.
What counts as CCM time.
Documented, practitioner-directed activities, separate from dispensing.
Barrier resolution
Resolving barriers like prior authorizations and therapeutic alternatives. Dispensing itself is not CCM time.
Care plan updates
Updating the comprehensive care plan under the billing practitioner’s direction as therapy response and health change.
Medication reconciliation
Reconciling medications across prescribers and fills, including OTC products and supplements.
Care coordination
Communicating with providers and team members to align care and avoid gaps.
Adherence coaching
Working through cost, side effects, understanding or transportation, within the care plan.
Transitions of care
Supporting patients after a hospital or ED visit to help prevent readmissions and complications.
Who enrolls, and who bills. Patients opt in by text first or enroll at your counter. A GenieMD physician decides eligibility (two or more chronic conditions), and patients already in CCM with another provider are never enrolled. GenieMD bills Medicare, not your pharmacy, and there is a $0 sign-up fee, with nothing charged to your pharmacy.
CCM may improve care coordination and help reduce avoidable hospitalizations and ED visits.
Five steps, start to finish.
Initiating visit & care plan
Under practitioner direction, patients are offered enrollment, the initiating visit is completed, informed consent is obtained, a care plan is established and 24/7 access to care is provided.
Patients appear in the portal
Eligible patients have two or more chronic conditions expected to last at least 12 months.
You reach patients your way
Phone, video, text or in person, using your own systems.
Perform care management
Carry out documented, medically necessary, practitioner-directed activities.
Time and notes are reported
Document activities and report time in the portal.
Documentation and key principles.
Documentation requirements
- Record activities and time in the medical record.
- Time is cumulative for the calendar month, with no minimum increment.
- Reflect the correct level: 20, 40 or 60 minutes.
- Activities must meet CCM requirements to count.
Key principles
- CCM time must be actual time spent on care management.
- Directed by the billing practitioner.
- Medically necessary.
- Not duplicative of dispensing or of services reimbursed under another arrangement.
Ask a PharmD, live, every week.
Hai Thai, PharmD, our Chief Clinical Officer, answers questions from pharmacy owners and pharmacists. Free, up to an hour, and never a sales call.
Let’s find the right fit for you.
Tell us a little about you. A real person on our Fort Wayne team reads every message and gets back to you within one business day.
Thanks, . We got it.
We’ll be in touch within one business day.