CCM + Internal Medicine
Chronic Care Management for Internal Medicine — August Health + CCN Health
Specialized CCM protocols for Internal Medicine — integrated with August Health, powered by CCN Health. Evidence-based workflows, automated documentation, and Medicare billing.
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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 Chronic Care Management (CCM) integration with August Health optimized for internal medicine practices, featuring glucose monitoring technology. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Chronic Care Management for Internal Medicine with August Health
CCN Health's CCM program integrates with August Health to provide internal medicine-specific clinical protocols, device monitoring, and automated Medicare billing for internal medicine patient populations.
Internal Medicine Conditions Managed
- Hypertension
- Diabetes
- Heart failure
- COPD
- Chronic kidney disease
- Metabolic syndrome
Glucose Monitoring for Internal Medicine
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.
This technology is particularly valuable for internal medicine patients because it provides fasting blood glucose, postprandial glucose, blood glucose trends data that directly informs clinical decision-making.
Clinical Protocols
- Multi-condition monitoring with condition-specific thresholds
- Preventive care integration with annual wellness visits
- Medication titration based on objective trending data
- Chronic disease management across multiple organ systems
Key Monitoring Metrics
| Metric | Clinical Significance |
|---|---|
| Blood pressure | Tracked and trended for internal medicine management |
| Blood glucose | Tracked and trended for internal medicine management |
| Weight | Tracked and trended for internal medicine management |
| SpO2 | Tracked and trended for internal medicine management |
| Heart rate | Tracked and trended for internal medicine management |
| Temperature | Tracked and trended for internal medicine management |
Recommended Devices for Internal Medicine
| Device | Use Case |
|---|---|
| Blood pressure monitor | Internal Medicine monitoring |
| Weight scale | Internal Medicine monitoring |
| Blood glucose meter | Internal Medicine monitoring |
| Pulse oximeter | Internal Medicine monitoring |
| Dexcom G7 CGM | Internal Medicine monitoring |
Relevant ICD-10 Codes
- I10 (Essential hypertension)
- E11.x (Type 2 diabetes)
- I50.x (Heart failure)
- J44.x (COPD)
- N18.x (CKD)
Clinical Evidence
Internal medicine practices implementing RPM programs see 15-25% improvements in chronic disease management quality metrics and patient satisfaction scores.
Billing & Reimbursement
| CPT Code | Reimbursement | Requirements |
|---|---|---|
| 99490 | ~$62/mo | 20+ minutes of clinical staff time per month |
| 99491 | ~$83/mo | 30+ minutes of physician/QHP time per month |
Monthly potential per patient: $62+
Frequently Asked Questions
How does CCM support internal medicine practices?
CCN Health's CCM integration provides internal medicine-specific monitoring protocols, automated documentation in August Health, and compliant Medicare billing for hypertension and related conditions.
What devices are recommended for internal medicine CCM?
For internal medicine patients, CCN Health recommends blood pressure monitor, weight scale, blood glucose meter based on the specific conditions being managed.
Can CCM data integrate with specialist workflows?
Yes. All CCM data flows into August Health and is available for specialist review, care plan updates, and cross-program coordination.
Internal Medicine
Internal Medicine Protocols — clinical workflows configured to evidence-based guidelines and risk thresholds.
Specialist Coordination — automated alerts and reporting to referring specialists and primary care teams.
Outcome Tracking — longitudinal vitals data mapped to Internal Medicine-specific quality measures.
Clinical Documentation — automated notes that satisfy specialist coding and audit requirements.
Purpose-built for Internal Medicine workflows — integrated with the EHR your facility already uses.
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.
Technology that stays in the background — so care stays in the foreground.
Why CCN Health
Why Internal Medicine Programs Choose CCN Health
Purpose-built technology that fits your clinical workflows and drives measurable outcomes.
Questions?
Want to learn more about Chronic 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 August Health
Your program data flows directly into August Health — no exports, no manual entry, no disruption to your clinical workflow.
Care Coordination
Calls, Assessments, Care Plans
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.
August Health
Charts & Care Plans
What Flows Between Systems
Patient Demographics
Chronic conditions, medications, and problem lists from your EHR
Care Plan Updates
Treatment plans and goals sync bi-directionally
Contact Logging
Phone calls and check-ins documented with timestamps
Medication Reconciliation
Current medication lists kept in sync across platforms
Time Tracking
Care management minutes tracked for billing compliance
Billing Documentation
CPT 99490/99491 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
Chronic Care Management (CCM)
3 billing codes
First 20 minutes of clinical staff time for CCM services
~$62
Monthly
Each additional 20 minutes of CCM clinical staff time
~$47
Monthly (additional)
First 30 minutes of physician/QHP time for complex CCM
~$83
Monthly
Common Questions
Frequently Asked Questions
Everything you need to know about Internal Medicine — implementation, billing, and clinical workflows.
Yes. CCN Health integrates with August Health to deliver RPM data directly into resident records, supporting senior care practices with automated vital sign documentation.
CCM is a Medicare program that reimburses providers for non-face-to-face care coordination for patients with two or more chronic conditions, billed under CPT codes 99490, 99439, and 99491.
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 Chronic Care Management for your Internal Medicine program.
Tell us about your organization
Share details about your Internal Medicine program, 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 Chronic Care Management to your Internal Medicine program?
See how CCN Health can improve patient outcomes, support specialist coordination, and generate new Medicare revenue — all within the EHR your staff already uses.