CCM + Endocrinology
Chronic Care Management for Endocrinology — PointClickCare + CCN Health
Specialized CCM protocols for Endocrinology — integrated with PointClickCare, powered by CCN Health. Evidence-based workflows, automated documentation, and Medicare billing.
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 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.
CCN Health provides a certified Chronic Care Management (CCM) integration with PointClickCare optimized for endocrinology 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 Endocrinology with PointClickCare
Endocrinology practices managing type 2 diabetes and type 1 diabetes can leverage CCN Health's CCM integration with PointClickCare for disease-specific monitoring, automated documentation, and compliant billing.
Endocrinology Conditions Managed
- Type 2 diabetes
- Type 1 diabetes
- Metabolic syndrome
- Thyroid disorders
- Obesity management
Glucose Monitoring for Endocrinology
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 endocrinology patients because it provides fasting blood glucose, postprandial glucose, blood glucose trends data that directly informs clinical decision-making.
Clinical Protocols
- Continuous glucose monitoring with time-in-range targets
- Threshold alerts for glucose < 70 or > 250 mg/dL
- Insulin dose adjustment based on CGM data
- Weight trending for metabolic syndrome management
Key Monitoring Metrics
| Metric | Clinical Significance |
|---|---|
| Blood glucose (fasting and postprandial) | Tracked and trended for endocrinology management |
| HbA1c trending | Tracked and trended for endocrinology management |
| CGM time-in-range | Tracked and trended for endocrinology management |
| Weight | Tracked and trended for endocrinology management |
| Blood pressure | Tracked and trended for endocrinology management |
Recommended Devices for Endocrinology
| Device | Use Case |
|---|---|
| Dexcom G7 CGM | Endocrinology monitoring |
| Blood glucose meter | Endocrinology monitoring |
| Weight scale | Endocrinology monitoring |
| Blood pressure monitor | Endocrinology monitoring |
Relevant ICD-10 Codes
- E11.x (Type 2 diabetes mellitus)
- E10.x (Type 1 diabetes mellitus)
- E66.x (Obesity)
- E03.x (Hypothyroidism)
Clinical Evidence
CGM-based RPM has been shown to improve time-in-range by 15-25% and reduce HbA1c by 0.5-1.0% in managed populations.
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 endocrinology practices?
CCN Health's CCM integration provides endocrinology-specific monitoring protocols, automated documentation in PointClickCare, and compliant Medicare billing for type 2 diabetes and related conditions.
What devices are recommended for endocrinology CCM?
For endocrinology patients, CCN Health recommends dexcom g7 cgm, blood glucose meter, weight scale based on the specific conditions being managed.
Can CCM data integrate with specialist workflows?
Yes. All CCM data flows into PointClickCare and is available for specialist review, care plan updates, and cross-program coordination.
Endocrinology
Endocrinology 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 Endocrinology-specific quality measures.
Clinical Documentation — automated notes that satisfy specialist coding and audit requirements.
Purpose-built for Endocrinology 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 Endocrinology 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 PointClickCare
Your program data flows directly into PointClickCare — 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.
PointClickCare
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 Endocrinology — implementation, billing, and clinical workflows.
Yes. CCN Health has a direct integration with PointClickCare, allowing vital-sign data from RPM devices to flow automatically into resident charts without manual entry.
Device readings are transmitted to CCN Health's platform and then pushed into PointClickCare via API, appearing alongside existing clinical documentation for a unified workflow.
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 Endocrinology program.
Tell us about your organization
Share details about your Endocrinology 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 Endocrinology 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.