PCM for Assisted Living
Principal Care Management for Assisted Living — Powered by Epic + CCN Health
Purpose-built PCM for Assisted Living communities. CCN Health integrates directly with Epic to automate clinical workflows and capture every eligible reimbursement.
CCN Health provides a certified Principal Care Management (PCM) integration with Epic designed specifically for assisted living communities. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Principal Care Management for Assisted Living with Epic
For assisted living organizations using Epic, Principal Care Management creates a powerful combination of clinical oversight and operational efficiency. CCN Health's integration handles the technical complexity so your care team can focus on resident care.
Assisted Living Challenges That PCM Addresses
- Monitoring residents who split time between their apartments and common areas
- Balancing assistance needs with resident autonomy and privacy
- Justifying staffing levels relative to resident acuity
- Differentiating your community in a competitive market
How It Works in Assisted Living
- Condition Identification — Identify a single high-complexity chronic condition requiring ongoing management
- Specialist Care Plan — Develop condition-specific management plan with measurable goals
- Focused Monitoring — Disease-specific metrics tracked and trended over time
- Epic Integration — Specialist coordination data and care plans sync with Epic automatically
- Billing Automation — Time tracking for CPT 99424-99427 documented automatically
Why Assisted Living Communities Choose CCN Health
Preserve Independence
Sensorless and wearable-free monitoring lets residents maintain daily routines without disruption.
Early Intervention
Real-time alerts enable staff to detect health changes before they become emergencies.
Family Engagement
Proactive monitoring gives families confidence their loved ones receive attentive care.
Competitive Advantage
Technology-enabled care differentiates your community and supports higher occupancy.
Devices for Assisted Living PCM
| Device | Use Case | Resident Experience |
|---|---|---|
| Condition-Specific Devices | Targeted monitoring | Devices matched to the principal condition |
| Specialist Dashboard | Disease tracking | Trend views for condition-specific metrics |
Clinical Benefits for Assisted Living
Chronic Disease Management
Monitor residents with conditions like hypertension, diabetes, heart failure, arthritis. Trending data helps care teams adjust care plans before conditions deteriorate.
Transition of Care Support
When residents return from hospital stays, PCM enables closer monitoring during the critical post-discharge period.
Billing & Reimbursement in Assisted Living
CCN Health automates Medicare PCM billing documentation for qualified residents:
| 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 resident: $70+
Frequently Asked Questions
Does CCN Health integrate with Epic for assisted living PCM?
Yes. CCN Health's certified Epic integration enables bi-directional data flow specifically designed for assisted living workflows.
What is the implementation timeline for assisted living?
Most assisted living communities are fully operational within 4 weeks, including integration setup, care staff training, and device deployment.
How does PCM billing work in assisted living?
CCN Health automatically documents the required data for 99424, 99425, 99426, 99427. Time tracking and transmission records are captured for audit-ready Medicare billing.
Implementation for Assisted Living
| Week | Activity |
|---|---|
| 1 | Discovery call and Epic configuration review |
| 2 | Technical integration setup and testing |
| 3 | Care staff training and device deployment |
| 4 | Pilot launch with select residents |
| 5+ | Full community rollout and optimization |
Discovery call — we learn your workflows, EHR setup, and resident population.
CCN's AI engine configures optimal alert thresholds and EHR data mapping around your facility's patterns.
Go live with AI-powered monitoring, automated documentation, and billing — your team stays focused on care.
No one-size-fits-all templates. Every integration is configured for how your Assisted Living actually operates.
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 Assisted Living Facilities Choose CCN Health
Purpose-built technology that fits your clinical workflows and drives measurable outcomes.
Seamless EHR Integration
How CCN Health Works Inside Epic
Your program data flows directly into Epic — no exports, no manual entry, no disruption to your clinical workflow.
Specialist Data
Condition Monitoring, Referrals
AI-Powered Platform
Intelligent data routing, anomaly detection, and automated documentation — working behind the scenes.
Epic
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 Epic via secure APIs, enabling RPM device data and care management documentation to flow into Epic's enterprise health records.
CCN Health transmits device readings and care coordination notes to Epic through FHIR-based APIs, ensuring clinical data is available within existing Epic workflows.
PCM focuses on patients with a single high-risk chronic condition, billed under CPT codes 99424 and 99425, covering care coordination and management services.
Assisted living residents use easy-to-operate devices that automatically transmit readings. Staff receive alerts for out-of-range values, enabling timely interventions while preserving resident independence.
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 TeamGet Started
Ready to bring Principal Care Management to your Assisted Living?
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.