Blood Glucose Monitoring for Skilled Nursing PCM — ALIS + CCN Health

Glucose Monitoring for Skilled Nursing PCM with ALIS and Epic

Skilled Nursing facilities using ALIS as their facility EHR often work with physicians who use Epic for their practice management. When implementing PCM with glucose monitoring, this dual-EHR reality creates data flow challenges that CCN Health solves through bi-directional integration with both systems.

The Dual-EHR Challenge in Skilled Nursing

In skilled nursing settings with glucose monitoring, it's common for:

• The facility to use ALIS for resident records, charting, and daily care documentation
• The physician to use Epic for orders, billing, and clinical decision-making
• Glucose Monitoring data to be needed in both systems for complete clinical documentation and billing

Without an integration bridge, glucose monitoring readings exist in isolation — staff must manually transcribe data between systems, leading to documentation gaps and billing delays.

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.

Data Captured

• Fasting blood glucose
• Postprandial glucose
• Blood glucose trends
• Hypoglycemia events
• Hyperglycemia events

How CCN Health Bridges ALIS and Epic

CCN Health's platform serves as the central hub for all glucose monitoring data in dual-EHR environments:

1. Glucose Monitoring data flows to CCN Health — Fasting blood glucose and other metrics are captured continuously by the monitoring system
2. ALIS receives resident records — Vital signs, alerts, and care documentation sync to ALIS resident charts automatically
3. Epic receives clinical summaries — The ordering physician gets PCM reports with glucose monitoring data in their Epic workflow
4. Billing documentation routes correctly — Claims data with glucose monitoring support goes to the billing entity via Epic

Data Flow: ALIS ↔ CCN Health ↔ Epic

Data Type	ALIS	CCN Health	Epic
Resident Demographics	Source	Syncs	Receives
Fasting blood glucose	Receives	Hub	Receives
Glucose Monitoring Alerts	Receives	Generates	Receives
Care Plans	Shared	Coordinates	Shared
Billing Documentation	Reference	Generates	Primary
PCM Time Tracking	Reference	Tracks	Primary

Benefits for Skilled Nursing Facilities

Combining glucose monitoring with dual-EHR integration provides unique advantages for skilled nursing facilities:

Readmission Prevention

Continuous monitoring during the critical post-acute window reduces hospital readmissions and improves quality scores.

Quality Measures

Objective vital sign data supports CMS quality reporting and star rating improvement efforts.

Glucose Monitoring Advantages

• Familiar fingerstick method — minimal learning curve
• Automatic cellular transmission eliminates manual logging

Billing Considerations for Dual-EHR Glucose Monitoring PCM

In dual-EHR environments with glucose monitoring, billing typically flows through the physician practice (Epic):

CPT Code	Reimbursement	Billing Entity	Documentation Source
99424	~$70/mo	Physician (Epic)	CCN Health → Epic
99425	~$56/mo	Physician (Epic)	CCN Health → Epic
99426	~$80/mo	Physician (Epic)	CCN Health → Epic
99427	~$64/mo	Physician (Epic)	CCN Health → Epic

Glucose Monitoring data provides the clinical documentation needed to support PCM billing with objective, time-stamped readings that demonstrate monitoring compliance.

Frequently Asked Questions

How does glucose monitoring data reach both EHR systems?

Data flows from the monitoring device to CCN Health's platform, then syncs bi-directionally with both ALIS (for resident care documentation) and Epic (for physician clinical records and billing).

Do both systems get the same glucose monitoring data?

Both systems receive glucose monitoring data, but formatted for each system's role. ALIS gets detailed resident charting, while Epic receives clinical summaries optimized for physician workflows and billing.

What is the implementation timeline for glucose monitoring with dual-EHR?

Most skilled nursing facilities are fully operational within 4-6 weeks, including system deployment, dual-EHR integration setup, and nursing staff training. Both EHR connections are configured simultaneously.