The Power of “In-Between Visit” Care: Turning Proactive Patient Management Into Recurring Revenue

Introduction:
In medicine, so much of what determines a patient’s outcome happens between visits — the medication changes, blood pressure trends, adjustments to better manage a chronic condition, or small questions that never make it to the next appointment. For years, those gaps were just part of the system. But with Chronic Care Management (CCM) and Remote Patient Monitoring (RPM), physicians can now turn that ongoing care into a structured, reimbursable, extension of their practice.

At CCMRPMHelp, we specialize in helping practices make this shift — transforming what was once unpaid work into meaningful patient engagement and predictable monthly revenue.

Proactive Care That Works Under Your Supervision

CCM allows your clinical staff; nurses, medical assistants, or care coordinators to manage patients under your supervision and bill for the time spent caring for them throughout the month. This time includes:

• Direct communication with patients and their families

• Coordination with pharmacies and specialists

• Reviewing test results, medications, or chronic conditions

• Documenting progress and updating care plans

Each interaction counts. Over the course of the month, these touchpoints typically add up to 20–60 minutes of care per patient — all reimbursable under Medicare’s CCM codes.

Adding RPM Unlocks a Higher Ceiling

When you introduce Remote Patient Monitoring, you elevate the level of insight and reimbursement potential.
RPM brings:

• Device reimbursement (for equipment such as blood pressure cuffs or glucose meters)

• Continuous data flow, allowing you to identify issues early

• Higher billable time as you integrate remote readings and follow-up actions into care

Together, CCM and RPM form a powerful combination, proactive management and continuous insight that benefit both the patient and the practice.

Real Impact

The results speak for themselves.

One of our favorite stories is a patient who called in just a month after enrolling in CCM to thank their physician for starting the program. They said it was the first time they truly felt connected and supported between visits.

That’s what these programs do — they make patients feel seen, cared for, and protected. Retention is exceptional because patients immediately notice the difference.

Revenue That Builds Month After Month

Beyond patient outcomes, the financial impact is undeniable.

For a practice with 150 enrolled patients, depending on how much time your team spends each month, recurring revenue can range from $30,000 to $60,000.

There is no other program a physician can implement that so directly improves patient care while generating that level of consistent income.

Why Practices Partner With CCMRPMHelp

Implementing CCM and RPM requires the right balance of process, technology, and people. That’s where we come in.

CCMRPMHelp provides the framework, documentation tools, and training to help you:

• Identify eligible patients

• Set up compliant workflows

• Train your staff to manage care effectively

• Start billing successfully within weeks

Our programs are built to help practices like yours deliver proactive, continuous care — without adding extra hours to your day.

Ready to See What’s Possible?

If your practice hasn’t yet implemented Chronic Care Management and Remote Patient Monitoring, now is the time.

These programs don’t just support your patients — they transform your business.

Visit CCMRPMHelp.com to schedule a discovery call and learn how to bring proactive care — and predictable revenue — into your practice.