CCM + Physical Medicine & Rehab
Chronic Care Management for Physical Medicine & Rehab — ALIS + CCN Health
Specialized CCM protocols for Physical Medicine & Rehab — integrated with ALIS, powered by CCN Health. Evidence-based workflows, automated documentation, and Medicare billing.
CCN Health provides a certified Chronic Care Management (CCM) integration with ALIS optimized for physical medicine & rehab practices. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Chronic Care Management for Physical Medicine & Rehab with ALIS
CCN Health's CCM program integrates with ALIS to provide physical medicine & rehab-specific clinical protocols, device monitoring, and automated Medicare billing for physical medicine & rehab patient populations.
Physical Medicine & Rehab Conditions Managed
- Stroke rehabilitation
- Spinal cord injury
- Traumatic brain injury
- Post-surgical rehabilitation
- Chronic pain management
Clinical Protocols
- Daily functional status assessment during rehabilitation
- Therapy adherence monitoring with automated reminders
- Pain trending to guide therapy intensity adjustments
- Discharge readiness scoring based on objective metrics
Key Monitoring Metrics
| Metric | Clinical Significance |
|---|---|
| Functional Independence Measure (FIM) | Tracked and trended for physical medicine & rehab management |
| Pain levels | Tracked and trended for physical medicine & rehab management |
| Range of motion | Tracked and trended for physical medicine & rehab management |
| Therapy session completion | Tracked and trended for physical medicine & rehab management |
| ADL performance | Tracked and trended for physical medicine & rehab management |
Recommended Devices for Physical Medicine & Rehab
| Device | Use Case |
|---|---|
| Functional assessment tool | Physical Medicine & Rehab monitoring |
| Pain scale tracker | Physical Medicine & Rehab monitoring |
| Activity monitor | Physical Medicine & Rehab monitoring |
| Therapy compliance tracker | Physical Medicine & Rehab monitoring |
Relevant ICD-10 Codes
- I63.x (Cerebral infarction)
- S14.x (Spinal cord injury)
- S06.x (TBI)
- G89.x (Pain disorders)
Clinical Evidence
RTM-supported rehabilitation programs demonstrate 25-40% faster functional recovery and 30% reduction in therapy dropout rates.
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 physical medicine & rehab practices?
CCN Health's CCM integration provides physical medicine & rehab-specific monitoring protocols, automated documentation in ALIS, and compliant Medicare billing for stroke rehabilitation and related conditions.
What devices are recommended for physical medicine & rehab CCM?
For physical medicine & rehab patients, CCN Health recommends functional assessment tool, pain scale tracker, activity monitor based on the specific conditions being managed.
Can CCM data integrate with specialist workflows?
Yes. All CCM data flows into ALIS and is available for specialist review, care plan updates, and cross-program coordination.
Physical Medicine & Rehab
Physical Medicine & Rehab 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 Physical Medicine & Rehab-specific quality measures.
Clinical Documentation — automated notes that satisfy specialist coding and audit requirements.
Purpose-built for Physical Medicine & Rehab workflows — integrated with the EHR your facility already uses.
Book a Discovery CallAI-Powered Alerts
Pattern recognition catches changes early
Smart Workflows
Automated routing and documentation
Automated Compliance
Real-time audit trail and billing validation
Advanced intelligence working behind the scenes — faster processing, smarter alerts, effortless documentation.
Technology that stays in the background — so care stays in the foreground.
Why CCN Health
Why Physical Medicine & Rehab Programs Choose CCN Health
Purpose-built technology that fits your clinical workflows and drives measurable outcomes.
Seamless EHR Integration
How CCN Health Works Inside ALIS
Your program data flows directly into ALIS — no exports, no manual entry, no disruption to your clinical workflow.
Care Coordination
Calls, Assessments, Care Plans
AI-Powered Platform
Intelligent data routing, anomaly detection, and automated documentation — working behind the scenes.
ALIS
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 Physical Medicine & Rehab — implementation, billing, and clinical workflows.
Yes. CCN Health integrates with the ALIS platform so that RPM readings sync directly into resident records, streamlining clinical workflows for senior living communities.
CCN Health transmits device data to ALIS through a secure API, ensuring vitals are available to caregivers inside the EHR they already use every day.
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.
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.
Talk to Our Team
Get Started
Ready to bring Chronic Care Management to your Physical Medicine & Rehab 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.