Every care coordination platform we assessed sells coordination. Not one tells you which Medicare programs pay for it, what those programs bill, or whether the revenue covers the software.
The coordination work your provider customers already do is billable under six separate Medicare programs, and each one demands something different from the system that runs it.
Map Your Programs to the CodesVendors in this space rarely compete head-on, they cluster into five distinct shapes, each built around a different setting and a different failure mode. Knowing which shape you're evaluating tells you what it will never do.
Home health, hospice, skilled nursing, discharge referral networks.
Community behavioral health clinics, state health-home programs.
Multi-specialty groups, accountable care organizations, federally qualified health centers.
Practices running one or two Medicare programs.
Platforms whose coordination model is the product.
Coordination is not an overhead line. Six Medicare programs pay for it, each with its own Current Procedural Terminology (CPT) codes, the billing codes used to report medical services, and each demanding a different capability from the software running underneath it.
| Program | Codes |
|---|---|
| Chronic Care Management (CCM) | 99490, 99439; complex 99487, 99489 |
| Principal Care Management (PCM) | 99424–99427 |
| Transitional Care Management (TCM) | 99495, 99496 |
| Behavioral Health Integration (BHI) | 99484; collaborative care 99492–99494 |
| Remote Therapeutic Monitoring (RTM) | 98975–98981, plus 98984 and 98985 |
| Advanced Primary Care Management (APCM) | G0556, G0557, G0558 |
What the software actually has to do, from eligible patient to reconciled billing.
An eligibility engine cross-references chronic condition count, discharge status, and current enrollments against the rules behind CCM, PCM, TCM, BHI, RTM, and APCM, and flags which programs a given patient qualifies for, often more than one at a time.
The PCP, specialist, and care manager are assigned, and a care plan opens in the structure the matched program requires: a single-condition plan for PCM, a multi-condition plan for CCM, a registry entry for BHI.
Clinical staff time, device data, consultant reviews, and outreach attempts are captured against the specific requirement of the code being billed, not a generic activity log retrofitted after the fact.
The system flags a patient approaching the monthly time threshold for CCM or PCM, a TCM contact window closing inside its two-business-day limit, or an RTM device supply period resetting at day 30, before the deadline is missed, not after.
Coordination notes, time logs, and care plan updates write back to the EHR via FHIR create calls, so the coordination work lives in one place instead of a shadow system nobody reconciles.
Eligible codes are compiled per patient per month with supporting documentation attached, alongside whether the coordination is actually closing the gap it was billed for: readmission rate, care gap closure, the relevant quality measure.
Fast, generic, one program, vendor owns the logic. For organizations with straightforward requirements, this is often the most practical option. If the organizations you serve run one or two standard programs in one setting, with no need to change enrollment or billing logic, buying is cheaper and faster, and you should buy.
Roughly 80% is already built and about 20% gets configured to your rules. Discharge intake, medication reconciliation, readmission monitoring, eligibility routing, and the per-patient program view already exist as documented components.
Right when the coordination itself is what you monetize. Also right when your requirement fails one of three checks: does its care-plan schema model coordination across the settings you actually work in, does it reach the EHRs your customers run, and can you change the rules without waiting on a release. If building is the answer, it means building it into your own product rather than bolting a second system beside it.
Three of the four vendors we assessed claim EHR integration without naming a single standard or a single EHR. Treat this as a checklist rather than a pitch.
The admission, discharge, and transfer messages hospitals emit, parsed and acknowledged. This starts a transitional care clock at the moment of discharge rather than when someone reads a fax.
Fast Healthcare Interoperability Resources is the current standard for exchanging clinical data through APIs. Read pulls the problem list and medications behind a care plan; create writes the coordination note back into the record of truth.
For the population pass: which attributed patients are eligible for which program, without anyone running a report by hand.
So the coordination view opens inside the clinician's existing session rather than as a second login, which separates a tool that gets used from one that gets demoed.
Send us the programs your provider customers run, and we'll map them to the CPT codes, capability requirements, and integration standards, before you commit engineering time.
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Software that organizes patient care activities and shares information among everyone involved in a patient's care, across settings and between encounters. It carries the parts that are state, timing and routing problems: who is accountable, what happens next, whether it happened. Assessment, goal setting and self-management support stay with people.
It has to be connected to the EHR, not necessarily separate from it. Most EHRs are built around the encounter and hold no state for the interval between encounters, which is where coordination lives. The options are a layer on top of the existing record, or coordination logic built into the product you already ship.
Six: chronic care management, principal care management, transitional care management, behavioral health integration, remote therapeutic monitoring, and advanced primary care management. Each has its own codes and its own documentation requirement, so a system that models one well often models the others badly.
It depends more on the integration surface than on the software. Where components are pre-built and the EHR exposes standard interfaces, the work is configuration and the timeline is weeks. Where the billing logic is custom, or the source system needs a non-standard interface, that piece sets the estimate and should be scoped separately rather than averaged in.
When your customers run one or two standard programs, in a single setting, with no need to change enrollment or billing logic. Buying is cheaper and faster there, and a build spends months arriving at what a vendor already ships. Building earns its cost when coordination is the product, or when the programs in play do not fit a vendor's fixed schema.
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