Blood Glucose Monitoring for Principal Care Management — Inside athenahealth
Blood Glucose data flows directly into athenahealth through CCN Health — powering your PCM program with real-time insights and automated billing.
Configurable Alerts
Set thresholds that match your clinical protocols
Flexible Workflows
Adapt routing, documentation, and permissions to your team
Automated Compliance
Real-time audit trail and billing validation
Advanced technology working behind the scenes — so your team gets faster processing, smarter alerts, and effortless documentation without changing how they work.
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Not ready for a call? No problem. Drop us a message and we'll get back to you within 24 hours with answers to your questions about Principal Care Management for your facility.
Tell us about your organization
Share details about your facility, current EHR setup, and what you're looking to achieve.
We'll review and respond
Our team will assess your needs and send you relevant information, case studies, or suggest next steps.
Connect when you're ready
When the time is right, we'll schedule a personalized demo tailored to your workflows.
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We'll get back to you within 24 hours.
CCN Health provides a certified Principal Care Management (PCM) integration with athenahealth, featuring glucose monitoring technology. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Discovery call — we learn your workflows, EHR setup, and patient population so nothing gets lost in translation.
We configure your platform around how your team actually operates — custom alert thresholds, EHR data mapping, and role-based permissions.
Go live with monitoring, automated documentation, and billing tailored to your practice — your team stays focused on care.
Glucose Monitoring for Principal Care Management with athenahealth
For organizations running PCM programs through athenahealth, glucose monitoring adds a critical monitoring dimension. FDA-cleared blood glucose meters from Trividia Health and Smart Meter use fingerstick testing with automatic cellular transmission. Results transmit to the CCN Health platform within minutes without patient interaction beyond the test itself.
How Glucose Monitoring Works
FDA-cleared blood glucose meters from Trividia Health and Smart Meter use fingerstick testing with automatic cellular transmission. Results transmit to the CCN Health platform within minutes without patient interaction beyond the test itself.
Vitals and Data Captured
- Fasting blood glucose
- Postprandial glucose
- Blood glucose trends
- Hypoglycemia events
- Hyperglycemia events
Key Advantages
- Familiar fingerstick method — minimal learning curve
- Automatic cellular transmission eliminates manual logging
- Real-time alerts for dangerous highs (>300) and lows (<70)
- Lower cost than CGM for stable diabetes management
- Ideal for patients who do not need continuous monitoring
Glucose Monitoring vs. Traditional Monitoring
| Factor | Glucose Monitoring | Traditional Methods |
|---|---|---|
| Test Method | Fingerstick with auto-upload | Fingerstick with manual logging |
| Data Transmission | Cellular — instant to platform | Paper log or manual entry |
| Alert Capability | Real-time hypo/hyperglycemia alerts | No alerting — reviewed later |
| Cost | Lower than CGM | Similar test strip costs |
| Clinical Oversight | 24/7 monitoring with escalation | Reviewed at appointments |
| Compliance Tracking | Automatic — every test logged | Relies on patient recording |
Ideal Use Cases
- Type 2 diabetes on oral medications
- Stable insulin-managed diabetes
- Pre-diabetes monitoring programs
- Skilled nursing glucose management
Glucose Monitoring in PCM Programs
When integrated with CCN Health's PCM program through athenahealth, glucose monitoring data flows automatically into the EHR and contributes to:
- Clinical Documentation — Monitoring data documented for care plan updates
- Billing Compliance — Data transmissions count toward 99425 requirements
- Alert Workflows — Abnormal readings trigger notifications to care staff via athenahealth
- Cross-Program Use — Glucose Monitoring data available across RPM, CCM, and other programs
Billing & Reimbursement
Glucose Monitoring data contributes to PCM billing requirements:
| CPT Code | Reimbursement | Requirements |
|---|---|---|
| 99424 | ~$70/mo | 30+ minutes of clinical staff time per month |
| 99425 | ~$56/mo | Each additional 30 minutes of clinical time |
| 99426 | ~$80/mo | 30+ minutes of physician/QHP time |
| 99427 | ~$64/mo | Each additional 30 minutes of physician time |
Monthly potential per patient: $70+
Frequently Asked Questions
How does glucose monitoring data flow to athenahealth?
Glucose Monitoring data is captured automatically and transmitted to the CCN Health platform, which syncs bi-directionally with athenahealth. No manual entry is required.
Does glucose monitoring qualify for PCM billing?
Yes. Glucose Monitoring data transmissions count toward the monitoring requirements for PCM CPT codes when combined with CCN Health's clinical oversight services.
What is the implementation process?
CCN Health handles the full setup: sensor deployment, alert configuration, athenahealth integration, staff training, and ongoing support.
Technology that stays in the background — so care stays in the foreground.
Why CCN Health
Why Healthcare Facilities Choose CCN Health
Purpose-built technology that fits your clinical workflows and drives measurable outcomes.
Questions?
Want to learn more about Principal Care Management for your facility?
Our team can answer your questions and show you how it works with your current workflow.
Seamless EHR Integration
How CCN Health Works Inside athenahealth
Your program data flows directly into athenahealth — no exports, no manual entry, no disruption to your clinical workflow.
Specialist Data
Condition Monitoring, Referrals
Built Around How You Operate
Custom workflows, smart alerting, and automated documentation — advanced technology working behind the scenes so your team doesn't have to.
athenahealth
Charts & Care Plans
What Flows Between Systems
Patient Demographics
High-risk conditions, specialist data, and medications
Condition Tracking
Disease-specific metrics monitored and trended
Specialist Coordination
Referral data and specialist notes synchronized
Care Plans
Condition-specific treatment plans inform monitoring
Time Tracking
Care management minutes tracked for billing compliance
Billing Documentation
CPT 99424/99425/99426/99427 records generated automatically
“Every reading, every alert, every care plan update — available across all your programs. One integration, unlimited use cases.”
Infrastructure
Medicare Billing
Automated Medicare billing documentation — every qualifying encounter captured and coded.
Medicare Billing
Principal Care Management (PCM)
2 billing codes
First 30 minutes of clinical staff time for PCM
~$70
Monthly
Each additional 30 minutes of PCM clinical staff time
~$54
Monthly (additional)
Common Questions
Frequently Asked Questions
Everything you need to know about implementation, billing, and clinical workflows.
Yes. CCN Health integrates with athenahealth so that RPM data flows directly into patient charts, reducing manual documentation and improving care coordination.
PCM focuses on patients with a single high-risk chronic condition, billed under CPT codes 99424 and 99425, covering care coordination and management services.
Patients use a connected blood glucose meter to take readings that transmit automatically to CCN Health's platform, supporting diabetes management with real-time trend visibility for clinicians.
Most facilities are fully operational within 2–4 weeks. CCN Health handles device provisioning, EHR integration setup, staff training, and ongoing clinical support.
Still have questions? We're happy to walk you through anything.
Contact Us
Prefer to Send a Message?
Not ready for a call? No problem. Drop us a message and we'll get back to you within 24 hours with answers to your questions about Principal Care Management for your facility.
Tell us about your organization
Share details about your facility, current EHR setup, and what you're looking to achieve.
We'll review and respond
Our team will assess your needs and send you relevant information, case studies, or suggest next steps.
Connect when you're ready
When the time is right, we'll schedule a personalized demo tailored to your workflows.
Send Us a Message
We'll get back to you within 24 hours.
Get Started
Ready to bring Principal Care Management to your facility?
See how CCN Health can improve resident outcomes, preserve independence, support family engagement, and generate new Medicare revenue — all within the EHR your staff already uses.