Structured monthly care for patients with multiple chronic conditions.
CCM gives your clinic a repeatable way to support high-need patients between visits — with the staffing, documentation, and billing workflows handled for you.
Program at a glance
- Chronic conditions
- 2+
- Monthly care time
- 20+ min
- Monthly revenue
- Recurring
What it is
Chronic Care Management (CCM) provides non-face-to-face care coordination for Medicare and eligible patients with two or more chronic conditions expected to last at least 12 months. Synexa stands up your CCM program with care plans, monthly outreach, time-based documentation, and reporting — so your providers stay focused on clinical decisions while patients receive consistent follow-through.
Clinical benefits
- Proactive management of diabetes, hypertension, CHF, COPD, and other chronic conditions
- Care plans and monthly touchpoints that meet CMS time-based billing requirements
- Improved medication adherence and reduced avoidable ED visits
- Predictable, recurring monthly revenue per enrolled patient
Who it's for
Built to plug into a wide range of clinic types and care models.
How it works
A fully managed rollout — we handle the operations so your clinic captures the clinical and financial benefits.
- 1
Identify & enroll
We help flag eligible patients across your panel and handle the enrollment outreach.
- 2
Deploy & train
Equipment, technicians, and workflows are set up inside your clinic — without disruption.
- 3
Deliver in-workflow
Testing or ongoing care happens within your existing visit flow, not around it.
- 4
Report & bill
Specialist reports return to the chart and we coordinate clean, compliant billing.
What's included
Everything needed to run the program end-to-end — bundled into one turnkey partnership.
Equipment Provided
We supply, deploy, and maintain all required testing devices on-site at your clinic.
Trained Technicians
Our certified technicians perform the testing so your clinical staff stays focused on patient care.
Specialist Interpretation
Board-certified specialists interpret every study and return clear, actionable reports.
Billing Coordination
We help coordinate billing workflows so the program runs as a clean revenue stream.
Frequently asked questions
The details clinics ask about most before getting started.
Which patients are eligible?
Medicare and eligible patients with two or more chronic conditions expected to last at least 12 months (or until death) qualify for CCM.
Who delivers the monthly care?
Synexa's care team handles monthly outreach, care plan upkeep, and time-based documentation under your providers' direction — your staff isn't pulled away from in-clinic work.
How is CCM billed?
CCM is billed monthly using CMS time-based codes. We capture the time and activity documentation required for compliant claims.
How is CCM different from PCM?
CCM is for patients with two or more chronic conditions, while PCM focuses on a single high-risk condition. We can help determine which fits each patient.
Ready to add preventive care programs to your practice?
Schedule a no-obligation walkthrough with our team. We'll show you how Synexa fits your clinic in 20 minutes.