HIPAA-Compliant · CCM + APCM · CPT 99490 · G0556–G0558

CCM + APCM billing software —
built for the patients who need it most.

Vigil Health handles the structured work of Chronic Care Management and Advanced Primary Care Management — automated patient check-ins, documented care plans, real-time alerts, hospitalization tracking, and audit-ready billing — so your care team can focus on what actually matters.

HIPAA-covered infrastructureAI call time excluded from billingCCM + APCM in one platformReal-time urgent alerts

How it works

Chronic patients get consistent support between appointments. Your practice stays on top of their care — and the documentation handles itself.

01

Build a real care plan

Every enrolled patient gets a documented care plan — chronic conditions, measurable goals, and a medication list. Not a formality. A living record your team actually uses.

02

Stay connected between visits

Automated check-in calls reach patients on a schedule that fits their needs. Ten structured health questions surface pain, medication problems, and emotional distress. The call time itself doesn't count toward the 20-minute threshold — your coordinator's follow-up work does.

03

Act fast when it matters

Urgent responses trigger real-time alerts to your care team. Everything is documented automatically, so your providers can focus on patients — not paperwork.

How CCM time actually works

AI call time

Automated check-in calls are structural outreach — not billable. Vigil excludes them at the data layer.

Coordinator review

Reviewing alerts, following up on calls, updating care plans — this is the 20 minutes that matters.

Manual documentation

Care plan edits, medication management, coordination with providers — all logged with timestamps.

CMS requires 20+ minutes of qualified clinical staff time per patient, per month — not automated system time. Vigil is built around this distinction from the ground up.

Everything CCM + APCM demands

The tools your care team needs to run both programs compliantly — chronic care management, advanced primary care, hospitalization tracking, and population reporting in one platform.

Automated Patient Outreach

AI-powered voice calls check in on enrolled patients on your schedule — daily, weekly, bi-weekly, or monthly. AMD voicemail detection included.

HIPAA-Grade Security

AES-256-GCM encryption for all PHI, mandatory two-factor authentication, AAL2 session enforcement, and an append-only audit trail.

Accurate Time Tracking

Session timers, manual logs, and precise start/end timestamps for every care activity. AI call time and telephony time are structurally excluded — only your team's work counts.

CCM + APCM Billing Ready

Full CPT 99490 / 99439 CCM workflow and APCM G-code billing (G0556, G0557, G0558). The system suggests the optimal program per patient each month so practices never leave reimbursement on the table.

APCM Program Support

Advanced Primary Care Management requires no time threshold — it bills on care management activities. Vigil tracks coordinator actions, surfaces the right G-code, and locks in a care plan snapshot at attestation.

Hospitalization Tracking

Log hospital admissions, ER visits, and SNF stays. Automatic follow-up task creation, due-date tracking, and resolution logging — built directly into the APCM attestation evidence trail.

AI Clinical Assistant

A Claude-powered assistant answers CCM and APCM protocol questions, care plan guidance, and billing code questions — without processing patient PHI.

Critical Alert System

AI classifies check-in responses by severity. Urgent alerts trigger coordinator SMS in real time. All alerts are tracked to resolution.

Structured Care Plans

Problem lists, measurable goals, interventions, and medication management — structured for documentation audits and CMS reviews. APCM attestations snapshot the active care plan.

MIPS & Population Health

Export APCM population metrics — contact rates, hospitalization rates, documentation quality — formatted for MIPS quality reporting. Year-over-year comparison built in.

Compliance Reporting

Printable monthly CCM billing summaries, APCM audit bundle exports, and outreach history — everything your billing department and compliance officer need.

Multi-Role Access

Separate login tiers for care coordinators, supervising providers, and practice admins — each scoped to only the data they need.

For your patients

Chronic illness doesn't pause
between appointments.

Patients managing diabetes, heart failure, COPD, or hypertension face daily challenges that their care team rarely gets to hear about. Medication side effects, worsening symptoms, and social stressors build up quietly in the weeks between visits.

Vigil calls them. Not a reminder, not a portal message — a real voice call that asks how they're doing, listens for warning signs, and connects them back to their care team the moment something sounds wrong.

Patients know someone is paying attention. That alone changes outcomes.

Never fall through the cracks

Regular scheduled calls mean no patient goes weeks without contact. For isolated or elderly patients, this connection is meaningful in itself.

Issues caught early

When a patient reports severe pain, trouble breathing, or can't afford their medication, the care team is alerted in real time — not at the next appointment.

A care plan that's actually used

Goals, medications, and interventions are documented and updated by the care team — not filed and forgotten. Patients have a team that knows their history.

Privacy protected by design

Every call, every response, every note is encrypted and secured to HIPAA standards. Patients' information is never shared, sold, or logged carelessly.

Built for the audit

Every minute logged.
Every step documented.

False Claims Act exposure, HIPAA enforcement, and Anti-Kickback risks are real. Vigil Health enforces the compliance requirements that other platforms leave to you — structurally, at the database level.

Initiating visit gate before CCM billing
Single-biller confirmation at consent
Patient-specific care plan with 5 structured fields
AI call time structurally separated from billable minutes
Consent revocation triggers automatic enrollment pause
24/7 access to care team attestation at enrollment
Provider attestation with immutable signature capture
Start/end timestamps on every time log entry
APCM coordinator actions logged for 3-action attestation
Care plan snapshot locked at APCM attestation time
Hospitalization follow-up tracked to resolution
RLS tenant isolation — no cross-practice data access possible
Vigil HealthPatient eligibility check
Initiating visit on file
CCM consent active
Single-biller confirmed
2+ chronic conditions
Care plan current
Minutes this month23 / 20 ✓
Honest expectations

What running CCM + APCM actually takes

We don't hide what these programs take to run well. Good care management is valuable because it requires a real human to do the work — not because it happens automatically.

A dedicated care coordinator

Vigil does the automated outreach. Your coordinator reviews alerts, follows up on flagged responses, updates care plans, and logs their time. Most panels of 50–100 patients take 8–12 hours per month.

Patient consent workflow

Every patient needs to opt in, have their consent documented, and confirm they're not enrolled elsewhere. Vigil tracks this — but your team needs to have the conversation.

Provider attestation

A supervising provider must review and attest to the care provided each month. Vigil builds the attestation flow — takes about 2 minutes per patient.

Initiating visit documentation

Patients must have had a qualifying visit with your practice before CCM billing begins. Vigil gates enrollment — you ensure the visit is on file.

Built for every role

How each team member uses Vigil

Every role gets a scoped view of the platform — only the data and actions relevant to their job. Select a role to see their features, workflow, and what they need to know.

Care Coordinator

8–12 hrs / 100 patients / month

The coordinator is the engine of the program. They handle daily patient contact, document every coordination activity, log hospitalization events, and prepare billing periods for provider review.

What they can do

  • Review AI-classified call responses each morning
  • Resolve and escalate urgent patient alerts
  • Log care coordination time (session timer or manual entry)
  • Document APCM coordinator actions (3 required per patient/month)
  • Log hospitalizations, admissions, and ER visits
  • Update patient care plans and medication lists
  • Schedule and adjust automated outreach frequency
  • Mark billing periods ready for provider attestation

Step-by-step workflow

1

Morning alert review

Open the Alerts tab. Vigil flags any check-in responses that mention severe pain, breathing difficulty, medication issues, or emotional distress. Work through the queue — resolve each alert, log your callback time, and document the outcome.

2

Log coordination time

Go to Time Log. Use the session timer for live work or manual entry for retrospective logging. Select the activity type (care coordination, care plan review, provider communication, etc.). Start and end timestamps are captured automatically.

3

Document APCM actions

For each APCM-enrolled patient, open their APCM Checklist. Log coordinator actions — care transitions follow-up, patient education, medication reconciliation, specialist communication, and more. Three documented actions are required before attestation.

4

Log hospitalizations

If a patient reports a hospital stay during a call or follow-up, open the patient record and log the admission. Record the admission date, facility, admission type, and whether follow-up is required. Vigil creates a follow-up task and tracks completion.

5

End-of-month billing prep

Go to Billing → Progress. Review each patient's CCM minutes or APCM action count. For patients who didn't hit the 20-minute CCM threshold, check whether APCM applies. Once ready, mark the billing period for provider attestation.

Key rule

Every minute you log and every action you document is the evidence base for billing. Vigil floors your totals once — it never rounds up — so every second you work compounds toward the threshold accurately.

Transparent pricing

One-time onboarding. Monthly per enrolled patient. No annual contracts.

Founding Practice ProgramLimited availability

We're enrolling our first cohort of practices. As a founding practice you get our full attention during onboarding, direct access to the product team, and a permanent discount on the setup fee — in exchange for honest feedback as we grow the platform together.

Standard setup fee

$1,000

Your setup fee

$500

50% founding discount

Monthly per patient

$25

enrolled patients only

Setup fee billed via ACH after we review and activate your account. Monthly billing begins with your first enrolled patient.

Everything included, no tiers:

Unlimited automated patient check-in calls
CCM + APCM billing — both programs, one platform
APCM G-code suggestion (G0556 / G0557 / G0558)
Hospitalization tracking + follow-up workflow
MIPS population health export
HIPAA-compliant infrastructure
CPT 99490 + 99439 billing workflow
Provider attestation + append-only audit trail
Critical alert SMS notifications
Structured care plans with 5 required fields
Monthly billing summaries and APCM audit exports
Dedicated onboarding support
BAA available on request

You pay only for enrolled patients. Monthly invoices via ACH — no cards, no auto-charge.

Pricing starts at $25/patient and scales down for larger panels. Talk to us about your panel size.

Open-book economics

The math for 80 enrolled patients — CCM + APCM

CCM and APCM are two of the few Medicare programs that directly pay for keeping patients out of the hospital. Here's a realistic combined example — 40 CCM patients hitting the 20-minute threshold plus 40 APCM patients across all three G-code tiers. Use the calculator to model your panel.

ItemMonthly (est.)
CCM 99490 × 40 patients (~$62 ea.)$2,480
CCM 99439 add-on × 12 patients (~$48 ea.)$576
APCM G0558 × 15 QMB patients (~$117 ea.)$1,755
APCM G0557 × 18 patients (~$50 ea.)$900
APCM G0556 × 7 patients (~$15 ea.)$105
Total Medicare billed (80 patients)~$5,816
Vigil platform (80 × $25)−$2,000
Net before coordinator time~$3,816

2024 national averages. Medicare GPCI adjustments, payer mix, and collection rates affect actual revenue. Coordinator time is not included — typical practices allocate 8–12 hours/month per 100 patients.

CCM + APCM Revenue CalculatorEstimates only
150
20600

CCM — CPT 99490 + 99439 (20-min threshold)

30
0150

APCM — no time threshold required

18
0100
22
0150
10
0100
Total enrolled patients80 / 150
CCM — 99490 × 30$1,860/mo
CCM — 99439 add-on (est. 30%)$432/mo
APCM — G0558 QMB × 18$2,106/mo
APCM — G0557 × 22$1,100/mo
APCM — G0556 × 10$150/mo
CCM subtotal$2,292/mo
APCM subtotal$3,356/mo
Vigil platform fee (80 pts)$2,000/mo
Net before coordinator time$3,648/mo

2024 national Medicare estimates: 99490 ~$62, 99439 ~$48, G0558 ~$117, G0557 ~$50, G0556 ~$15. Actual rates vary by locality (GPCI), payer mix, and collection rate. Coordinator time is not included — typical practices allocate 8–12 hours/month per 100 patients.

Who is eligible — CCM vs. APCM?

CMS sets the eligibility requirements. Vigil enforces them at enrollment and suggests the higher-reimbursing program for each patient each month.

CCM — CPT 99490~$62/patient/mo

Initiating visit on file

Patient must have had a face-to-face visit with your practice within the past 12 months.

Two or more chronic conditions

Diagnosed and documented. Expected to last at least 12 months or until death.

Medicare as primary payer

Part B must be primary. Medicare Advantage plans vary — verify coverage before enrolling.

Patient consent on file

Verbal or written. Must include single-biller confirmation. Vigil tracks consent status and blocks billing if revoked.

APCM — G0556 / G0557 / G0558up to ~$117/mo (QMB)

Medicare Part B as primary payer

Same as CCM — Medicare Part B must be primary. Medicare Advantage plans vary.

One or more chronic conditions

APCM requires only 1+ chronic condition (vs. CCM's 2+). G-code tier is determined by condition count and QMB status.

QMB status unlocks G0558

Qualified Medicare Beneficiaries (low-income subsidy) qualify for G0558 — the highest-reimbursing APCM code at ~$117/month.

No monthly time minimum

Unlike CCM, APCM has no 20-minute threshold. Billing is based on documented care management activities — coordinator actions, care plans, hospitalizations.

A patient can be enrolled in CCM or APCM — not both simultaneously. Vigil tracks program selection per billing month and prevents duplicate billing.

Our story

Why we built Vigil

People living with two or more chronic conditions spend most of their lives outside the doctor's office. They manage medications, symptoms, and setbacks largely on their own — and too often, small problems become serious ones before anyone on their care team finds out.

Medicare's Chronic Care Management program was designed to change that. It funds the between-visit care that independent practices already want to provide — regular check-ins, documented care plans, and a care team that stays connected. But the administrative burden of running a real CCM program has kept most small practices from doing it well.

Vigil removes that burden. We built the infrastructure — secure, compliant, and purpose-built for independent practices — so care coordinators can focus on patients instead of paperwork.

Better outcomes for patients. Less administrative overhead for practices. That's the whole idea.

Taking care of patients

Chronically ill patients spend most of their lives outside the doctor's office. Vigil calls them monthly, catches problems early, and makes sure no one falls through the cracks between visits.

Taking care of doctors

Independent practices want to provide great between-visit care — they just can't afford the administrative burden of running it manually. Vigil handles the calls, documentation, and billing so physicians can focus on medicine.

Helping Medicare save money

Preventable ER visits and hospital admissions cost Medicare billions each year. Consistent monthly check-ins catch deteriorating conditions before they escalate — keeping patients healthier and out of the emergency room.

Your chronic patients deserve more
between-visit support.

The Founding Practice Program is open now. Submit your practice and we'll reach out within 24 hours to get you started. No sales call required.

Get in touch

Evaluating CCM platforms? Want to see a walkthrough? Have compliance questions? We respond to every message within one business day.

Founding Practice Program details
Compliance and HIPAA questions
Scheduling a live walkthrough
Technical integration questions

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