PCM for Senior Living
Principal Care Management for Senior Living — Powered by Epic + CCN Health
Purpose-built PCM for Senior 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 senior living communities. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Principal Care Management for Senior Living with Epic
Implementing PCM in senior living settings requires an integration that understands both the clinical needs of independent and assisted living residents aged 65+ who value autonomy while benefiting from proactive health monitoring and the workflows of Epic. CCN Health bridges this gap.
Senior Living Challenges That PCM Addresses
- Balancing resident independence with clinical oversight
- Managing chronic conditions across a diverse acuity spectrum
- Demonstrating health outcomes to families considering placement
- Generating additional revenue without increasing staffing burden
How It Works in Senior 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 Senior Living Communities Choose CCN Health
No Wearables Required
Xandar Kardian sensorless monitoring captures vitals without devices residents need to wear, preserving independence and dignity.
Revenue Generation
Medicare reimbursement adds new revenue per resident per month with automated billing documentation.
Family Confidence
Proactive monitoring gives families peace of mind, improving satisfaction and occupancy rates.
Staff Efficiency
Automated vital charting eliminates manual data entry, giving staff more time for direct resident care.
Devices for Senior 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 Senior Living
Chronic Disease Management
Monitor residents with conditions like hypertension, diabetes, heart failure, COPD. 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 Senior 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 senior living PCM?
Yes. CCN Health's certified Epic integration enables bi-directional data flow specifically designed for senior living workflows.
What is the implementation timeline for senior living?
Most senior living communities are fully operational within 4 weeks, including integration setup, care staff training, and device deployment.
How does PCM billing work in senior 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 Senior 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 Senior 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 Senior 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.
Residents use simple connected devices in their rooms. Readings transmit automatically to CCN Health's platform and into the facility's EHR, alerting staff to concerning trends before they become emergencies.
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 Senior 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.