Consent before anything
Chronic care, remote monitoring, principal care or behavioural health: enrolment is refused without recorded consent, and no time counts without it.
Clinical / Care programmes
Chronic care and home monitoring, where the month’s evidence decides what is billable.
Enrolment with recorded consent, minutes of care and home readings counted per month, and thresholds that flag a worrying reading. Nobody ticks “billable”: the month’s own minutes and readings decide, and what is missing shows while there is still time.
What it does
Care programmes, in practice
Minutes and readings
Staff log minutes — whether they spoke to the patient, whether it was the clinician’s own time — and home readings. Totals are per enrolment, never pooled across programmes.
Codes from the evidence
Chronic care (99490 and 99439, or 99487 and 99489 when complex) and remote monitoring (99454 for sixteen reading days, 99457 and 99458 for interactive time) are worked out from the month’s own figures.
What is missing, in time
While the month is open it says what is still needed — “readings on 3 more days would reach 99454”.
Out-of-range readings
Readings outside a patient’s limits are flagged and listed for review, and a resent reading cannot add an extra day.
How it works
From the first step to the last
- 1
Enrol
With the patient’s recorded consent.
- 2
Record
Minutes and readings through the month.
- 3
Bill
The month qualifies on its own evidence; a biller decides.
What it needs
Before you switch it on
Every module switches on and off by itself, per clinic, with its own screens, permissions and audit trail.
Worth knowing
It works out what a month qualifies for but does not submit claims. Home readings are entered by hand — there is no device integration — and the code thresholds, checked against the CY2026 fee schedule, can be adjusted.
See Care programmes working on a real system.
The demo runs every module against an unmodified OpenEMR, with invented patients. Nothing to install and no sales call.