12 CCM Red Flags: Things to Absolutely Avoid When Selecting Your Chronic Care Management Vendor
Dr. Miller, a primary care physician, had finally decided to expand her practice’s chronic care offerings. Chronic Care Management (CCM) promised stronger patient outcomes, additional recurring revenue, and alignment with value-based care, all for a very attaractive cost. She carefully evaluated a vendor’s proposal, but within months of launch, the program faltered. Calls were handled by non-clinical overseas agents, billing errors led to denied claims, and revenue was far less than projected. The practice’s reputation suffered, and Dr. Miller had to start over.
Stories like Dr. Miller's are not uncommon. Choosing the wrong CCM partner can undermine the very goals of launching the program: improving patient outcomes, supporting care teams, and creating sustainable revenue. To help practices avoid these pitfalls, here are the red flags you should watch for when selecting a CCM vendor.
Why CCM vendor selection matters
CCM is more than just billing a CPT code. Under CMS requirements, CCM is furnished to patients with two or more chronic conditions expected to last at least 12 months (or until death) that place the patient at significant risk. Services include non–face-to-face care coordination such as a comprehensive, shareable electronic care plan, documented patient consent, 24/7 access and continuity, and a monthly contact cadence. It is billed per calendar month, and only one billing practitioner may bill CCM for a given patient each month.
Because these elements demand reliable clinical judgment, complete documentation, and audit-ready reporting, the choice of the CCM vendor is pivotal: a great CCM vendor is going to perform like a partner that helps grow the provider's revenue, improve health outcomes, and enhance the health provider's reputation.
12 red flags to avoid when choosing a CCM vendor
When selecting a CCM vendor, there are some clear red-flags one can be on the watch-out for, and that can help avoiding bad choices:
1) Lack of qualified medical staff. A serious concern arises when a CCM vendor cannot supply its own clinical staff, or when the staff they provide lack appropriate qualifications, training, and experience. Practices often look to CCM partners to expand capacity; if the vendor cannot deliver staff, the burden falls back on the practice. At the same time, CCM activities require clinical judgment: medication reconciliation, symptom triage, care-plan updates, not scripted call-center work. If the outreach is performed by untrained, unqualified, inexperienced staff, patients loose trust and important clinical clues may be missed. A good CCM vendor offers dedicated staff who are licensed (RNs, LPNs or MAs) and experienced in chronic care coordination, with training aligned to CMS and AMA expectations.
2) Non–US-based / offshore care teams Offshore staffing may lower vendor costs, but it introduces serious issues for compliance. Medicare does not allow CCM services to be furnished outside the United States for reimbursement purposes. Even if offshore staff followed HIPAA safeguards, claims submitted for CCM work performed offshore would not meet CMS billing requirements.
3) Payment structure not aligned with your success. Avoid models that charge high upfront fees or per-member monthly charges irrespective of reimbursed claims or actual engagement. A strong partner aligns incentives with your outcomes, tying fees to successfully reimbursed claims and verifiable engagement or quality metrics.
4) Lack of billing expertise and support. Even clinically strong CCM fails without accurate billing and documentation. CMS expects audit-ready time logs, care-plan updates, and evidence of monthly non–face-to-face services. A competent CCM partner should provide compliant templates, accurate time capture, and clean claims to minimize denials and clawbacks. More importantly, they should be well verse in the reimbursement rules and requirements, not just staffing or software development.
5) Weak patient engagement. Chronic Care Management depends on consistent, structured monthly interactions. A red flag is a vendor that relies on minimal outreach or generic scripts, which may check the box but fail to build trust or capture meaningful clinical insights. Patients who don’t feel heard or supported quickly disengage, and disengagement has a direct financial consequence: if patients aren’t engaged every month, the practice cannot bill for those months. A CCM program only delivers full value—both in terms of improved outcomes and reliable recurring revenue—when patients are consistently active. Look closely at how a vendor structures engagement: Are monthly calls clinically informed? Do coordinators document follow-through and escalate concerns promptly? Does the vendor have processes to re-engage patients who miss a month? Without strong protocols, your program risks becoming sporadic, undermining both patient care and your revenue potential.
6) Lack of HIPAA compliance. If a vendor cannot produce evidence of a solid HIPAA setup being in place, including BAAs, security risk analyses, workforce HIPAA training records, and details on encryption or access controls, walk away. HIPAA compliance is non-negotiable.
7) Lack of interoperability with your EHR. While not a billing requirement for CCM, inability to integrate with your EHR is a practical red flag. It invites duplicate documentation, stale care plans, and missed updates, all of which increase compliance risk and staff burden. Seek vendors who can exchange patient-level data (care-plan updates, monthly notes, time logs) with your EHR or data layer to create one source of truth.
8) No transparency or limited reporting. If a vendor cannot show engagement rates, time tracking, care-plan status, and billing summaries, they’re asking you to operate blind. Reporting must be complete, timely, and easily auditable to support compliance and continuous improvement.
9) Narrow service offering. A strong CCM vendor can help your practice think beyond CCM alone. If a vendor lacks complementary programs like Remote Patient Monitoring (RPM), Transitional Care Management (TCM), or Advanced Primary Care Management (APCM), your ability to enhance patient experience, improve outcomes, and drive revenue growth will be limited. A narrow service offering locks your practice into a single lane, constraining patient enrollment, limiting your ability to build comprehensive care plans, and ultimately reducing the financial upside of value-based care. Look for vendors that provide a broad suite of programs that can work together, so you can scale flexibly as your patients’ needs and your practice’s strategy evolve.
10) No software-only option. Your practice’s needs today may not be the same two years from now. Vendors that only offer a single delivery model, such as a fully staffed solution, force you into unnecessary vendor changes when your strategy shifts. By contrast, a vendor that supports both fully staffed and software-only models gives you flexibility. You can move from outsourced staff to in-house staff (or vice versa) without dismantling the program or re-training your patients. This future-proofs your investment, saves time and money, and makes transitions smoother for both your clinical team and your patients.
11) Lack of benefit to non-enrolled patients. Not every eligible patient will choose to enroll in a non–face-to-face care management program, but that doesn’t mean they should be left behind. A red flag is a vendor whose solution only benefits enrolled patients, leaving the rest of your population untouched. The best CCM vendors design systems, workflows, and insights that elevate care for all patients—whether that’s through automated gap closure alerts, health education resources, or better-coordinated communication. A solution that drives broader benefits across your entire patient panel will strengthen clinical outcomes, streamline operations, and reinforce your practice’s reputation for comprehensive, proactive care.
12) Lack of robust features to support quality and oversight. A CCM program should always operate under the clinical direction of the patient’s primary provider. A major red flag is when a vendor limits your ability to oversee the care being delivered to your patients. Without transparent reporting, access to call notes, and alignment with your standards of care, you can’t verify that patients are receiving high-quality support. Worse, lack of oversight raises compliance risks if billed services don’t reflect true clinical engagement. The right vendor keeps the medical provider firmly in control: offering dashboards, detailed documentation, and regular feedback loops so you can confirm that care is being delivered appropriately and consistently.
Implementation strategy: how to choose wisely
- Interview vendors thoroughly. Ask about staffing, licensure mix, clinical supervision, and whether staff are US-based.
- Review payment models. Favor success-aligned models tied to reimbursed claims and engagement; avoid large fixed fees with little accountability.
- Demand HIPAA proof. Ensure you have BAA, privacy and security documentation, and workforce training attestations.
- Check for EHR interoperability. Ask to see how care-plan updates and monthly notes enter your charting environment; clarify data standards and reconciliation workflows.
- Validate that time logs, outreach attempts, care-plan changes, and billing files are audit-ready.
Conclusion
The promise of CCM is clear: better patient outcomes, stronger relationships, and predictable recurring revenue. The wrong vendor can jeopardize all three. By avoiding red flags, unqualified / offshore staff, lack of HIPAA safeguards, misaligned payment models, weak billing support, thin engagement, non-interoperable workflows, and opaque reporting—you protect both your patients and your practice. Choosing wisely ensures your CCM program thrives not just on paper, but in the day-to-day lives of patients who depend on it. Ready to enhance the care to your patients and grow your bottom line? Book a demo with Lara Health and see how a clinically grounded, compliant CCM solution delivers results you can trust.
FAQs
Does the care staff need to be in the US?
Not legally, but claims submitted for CCM work performed offshore would not meet CMS billing requirements.
Can a CCM vendor operate without EHR interoperability?
Yes, but it creates operational risk such as duplicate documentation, stale plans, and missed updates. Interoperability is a best practice—not a billing requirement—because it improves compliance and care continuity.
What should reporting include?
Audit-ready logs of monthly contact and time, care-plan updates, outreach attempts, and billing files. The absence of this transparency is a red flag.
How do we evaluate a vendor’s payment structure?
Prefer models that tie vendor fees to reimbursed claims and engagement or quality metrics; avoid fixed fees that continue despite denials or low outreach.
References
CMS — Chronic Care Management Services Booklet (MLN909188), 2025
AMA — CPT® 2025 Professional Codebook
ONC — Interoperability and USCDI Guidance, 2023–2024
HHS OCR — HIPAA Privacy and Security Rules, Business Associate Agreements, current
