Unlock Recurring Medicare Revenue While Elevating Patient Care
Most primary care clinics have hundreds of CCM-eligible patients — yet only a fraction are consistently enrolled and managed.
Chronic Care Management (CCM) is a Medicare-covered benefit for patients with two or more chronic conditions expected to last at least 12 months. When executed properly, CCM improves patient continuity while generating predictable monthly reimbursement.
The challenge isn’t eligibility. It’s structured execution.
Eleos Virtual Healthcare Solutions deploys dedicated Virtual Healthcare Associates (VHAs) who operationalize CCM inside your existing workflows — compliantly, consistently, and at scale.
Why CCM Is a Strategic Opportunity for Your Clinic
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Improve Patient Outcomes - Structured monthly support helps identify issues early, reinforce medication adherence, coordinate care, and reduce avoidable escalations.
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Capture Recurring Medicare Revenue - CCM converts care coordination your clinic is already attempting into compliant, billable monthly reimbursement.
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Protect Provider Time - Your VHA manages outreach, documentation, care plan updates, and coordination — allowing providers to focus on clinical oversight and decision-making.
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Scale Without Expanding Headcount - Deploy CCM support virtually — no additional in-office staff required.
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Think of them as your clinic’s dedicated care coordinator—helping patients stay proactive in their health while reducing the burden on providers and onsite staff.
What CCM Requires (And What We Execute)
CCM services are delivered outside traditional office visits and must meet Medicare documentation and time requirements.
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Core CCM Service Elements
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Development and ongoing maintenance of a comprehensive electronic care plan
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Monthly non-face-to-face patient outreach
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Medication reconciliation and adherence review
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Coordination with specialists and other providers
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Monitoring of chronic condition status and care gaps
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Documentation and compliant time tracking
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Communication updates to providers and care team
This ensures your clinic delivers structured, compliant care management — not inconsistent follow-up calls
Optional Turnkey CCM Enrollment & Compliance Support
Execution begins with enrollment.
Eleos provides a structured, turnkey enrollment model to help your clinic activate eligible patients quickly and compliantly.
Your CCM Specialist:
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Conducts outreach to patients identified by your clinic as CCM eligible
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Educates patients on CCM services and benefits
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Secures and documents required patient consent
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Builds the initial comprehensive care plan
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Transitions patients into recurring monthly management
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Manages annual re-enrollment and consent renewal to prevent revenue gaps
Without structured enrollment and annual tracking, clinics often lose eligible patients — and recurring revenue.
*Turnkey enrollment and annual re-enrollment services may involve an additional fee depending on panel size and enrollment goals.
Medicare Reimbursement: The Financial Impact
CCM is reimbursed under the Medicare Physician Fee Schedule.
*Rates vary by locality and payer mix. Source: ThoroughCare
What This Means Financially
Using base CCM (99490 only):
Add-on time and complex CCM increase this opportunity further.
Many clinics are sitting on six-figure recurring revenue simply because they lack structured execution.
Execution — not eligibility — determines performance.
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Bilingual, College-Educated Medical Doctors—Providing High-Quality Support at a Cost-Effective, All-Inclusive Rate Covering Taxes, Benefits, PTO, and More.
Who This Is Ideal For
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Primary care clinics with 100+ eligible Medicare patients
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Practices participating in Value-Based Care contracts
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Clinics that attempted CCM but struggled with consistent execution
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Groups seeking predictable recurring Medicare revenue
Compliance & Oversight
CCM services are delivered under the supervision of the billing practitioner.
The provider retains clinical oversight and medical decision-making authority.
The VHA executes operational components — including outreach, documentation, care plan maintenance, and time tracking — under general supervision consistent with CMS guidelines
Turn Eligibility Into Execution
If your clinic has eligible Medicare patients but no structured CCM engine, you are leaving both patient continuity and recurring revenue on the table.
Eleos provides the staffing, workflow integration, and operational discipline to transform CCM into a dependable clinical and financial asset.
