BHI + Geriatrics
Behavioral Health Integration for Geriatrics — Epic + CCN Health
Specialized BHI protocols for Geriatrics — integrated with Epic, powered by CCN Health. Evidence-based workflows, automated documentation, and Medicare billing.
CCN Health provides a certified Behavioral Health Integration (BHI) integration with Epic optimized for geriatrics practices. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Behavioral Health Integration for Geriatrics with Epic
For geriatrics patients in facilities using Epic, BHI enables systematic behavioral health screening with data flowing directly into the EHR.
Geriatrics Conditions Managed
- Multi-morbidity
- Frailty
- Polypharmacy management
- Fall prevention
- Cognitive decline
- Malnutrition risk
Clinical Protocols
- Comprehensive vital sign monitoring across multiple conditions
- Fall risk assessment and continuous monitoring
- Medication management with polypharmacy review
- Functional status tracking for aging-in-place support
Key Monitoring Metrics
| Metric | Clinical Significance |
|---|---|
| Blood pressure | Tracked and trended for geriatrics management |
| Weight | Tracked and trended for geriatrics management |
| Heart rate | Tracked and trended for geriatrics management |
| SpO2 | Tracked and trended for geriatrics management |
| Activity levels | Tracked and trended for geriatrics management |
| Sleep patterns | Tracked and trended for geriatrics management |
Screening Instruments
| Instrument | Use Case | Details |
|---|---|---|
| PHQ-9 | Depression screening | 9-item questionnaire, scored 0-27, tracks severity and treatment response |
| GAD-7 | Anxiety screening | 7-item questionnaire, scored 0-21, identifies generalized anxiety disorder |
| PHQ-2 | Depression pre-screen | 2-item rapid screen, gateway to full PHQ-9 if positive |
| Columbia Suicide Severity Rating Scale | Suicide risk assessment | Structured interview for suicide ideation and behavior |
| Montreal Cognitive Assessment (MoCA) | Cognitive screening | 30-point test for mild cognitive impairment detection |
Relevant ICD-10 Codes
- R54 (Age-related physical debility)
- R26.x (Abnormalities of gait and mobility)
- Z73.x (Problems related to life management)
- R41.x (Cognitive function symptoms)
Clinical Evidence
Comprehensive geriatric monitoring programs reduce hospitalizations by 20-35% and support longer independent living periods in senior populations.
Billing & Reimbursement
| CPT Code | Reimbursement | Requirements |
|---|---|---|
| 99484 | ~$48/mo | 20+ minutes of clinical staff time per month |
| 99492 | ~$163 | Initial psychiatric collaborative care (70+ min first month) |
| 99493 | ~$130/mo | Subsequent psychiatric collaborative care (60+ min) |
Monthly potential per patient: $48+
Frequently Asked Questions
How does BHI support geriatrics practices?
CCN Health's BHI integration provides geriatrics-specific monitoring protocols, automated documentation in Epic, and compliant Medicare billing for multi-morbidity and related conditions.
What devices are recommended for geriatrics BHI?
For geriatrics patients, CCN Health recommends blood pressure monitor, weight scale, pulse oximeter based on the specific conditions being managed.
Can BHI data integrate with specialist workflows?
Yes. All BHI data flows into Epic and is available for specialist review, care plan updates, and cross-program coordination.
Geriatrics
Geriatrics 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 Geriatrics-specific quality measures.
Clinical Documentation — automated notes that satisfy specialist coding and audit requirements.
Purpose-built for Geriatrics 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 Geriatrics Programs 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.
BH Assessments
PHQ-9, GAD-7, Screenings
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
Behavioral health diagnoses, medications, and history from your EHR
Screening Scores
PHQ-9, GAD-7, and assessment results posted to patient charts
Intervention Notes
Behavioral health interventions documented and time-stamped
Care Coordination
Psychiatric consult notes and referral tracking
Time Tracking
BHI care management minutes tracked for 20-min threshold
Billing Documentation
CPT 99484/99492/99493 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
Behavioral Health Integration (BHI)
1 billing codes
Care management for behavioral health conditions
~$48
Monthly
Common Questions
Frequently Asked Questions
Everything you need to know about Geriatrics — 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.
BHI enables billing for care management services for patients with behavioral health conditions, using CPT codes 99484, 99492, and 99493.
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 Behavioral Health Integration to your Geriatrics 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.