Opexia builds custom operations software for organizations running CCM, PCM, RPM or APCM programs that have outgrown spreadsheets or rigid vendor tools: third-party care-management companies, MSOs and practices running programs in-house. We build patient rosters, minute tracking with an audit trail, monthly verification, and reports and invoices generated from CPT paycode counts. Our team built a platform of this kind for a US CCM/PCM organization as it grew from about 3,200 to 8,000+ patients.
If several of these sound familiar, the workflow has outgrown the tool:
Minutes, notes and paycodes get reconciled across files in the last days of every month.
Anyone with the file can edit a time log, and nothing records who changed what or when.
Each practice's monthly invoice is assembled from spreadsheets instead of generated from the minutes.
Every newly enrolled patient adds to the software bill, so growth costs more each month.
Keeping each practice's patients, staff and reports separate depends on file permissions and discipline, not the system.
Care-management billing runs on documented time. Standard CCM (CPT 99490) requires at least 20 minutes of clinical staff time per patient per calendar month, and PCM at least 30 minutes per month for a single high-risk condition. When those minutes live in spreadsheets, every month ends the same way: reconciling logs, verifying progress and building each partner practice's invoice by hand. We build the operations layer that replaces that work: a patient roster, minute capture that records who logged time for which patient and when, monthly verification, and reports and invoices generated from CPT paycode counts. For organizations serving several practices, each one can run in its own isolated tenant. The software is built to HIPAA requirements (encryption, audit logging, role-based access), sits beside your EHR rather than replacing it, and you own the source code on final payment.
Custom CCM and PCM time tracking: minutes logged by staff member, patient and month, an append-only audit trail, and paycode counts that feed invoices.
We connect RPM vendors to your care-management software: enrolled-patient sync, device readings matched to patients and days-of-data tracking rules.
We move care-management rosters, minute logs and paycodes from spreadsheets into a platform: column mapping, row validation, a parallel run and cut-over.
Monthly invoices to partner practices generated from CPT paycode counts and each practice's terms, plus progress and performance reports in Excel and PDF.
Custom software for Advanced Primary Care Management (G0556–G0558): consent, patient tiers, service-element evidence, overlap flags and population reports.
| Option | Pricing model | Multi-practice support | Partner-practice invoicing | Audit-trail control | Data ownership | Time to start |
|---|---|---|---|---|---|---|
| Per-patient SaaS | A monthly fee for each enrolled patient, so the bill grows with the panel. | Depends on the product; check whether one account can hold several practices with their data kept apart. | Built around billing exports; invoices to partner practices in your own format are often assembled outside the tool. | The vendor's log, showing what the product chooses to record. | Your data under the vendor's terms; check the export format and exit terms. | Fastest: sign up, configure and train. |
| Full-service or revenue-share vendor | A share of program revenue, or a per-patient fee that includes the vendor's staff. | The vendor runs the program; you do not operate the software. | Handled by the vendor as part of the service. | Held by the vendor; the billing practice relies on the vendor's records if it is audited. | Governed by the service contract. | Fast: the vendor brings its own staff and software. |
| White-label or staffed platform | A platform licence, often per patient or per seat, sometimes bundled with staffing. | Usually supported, within the platform's own model. | Available where the platform supports it, in the platform's formats. | The platform's log, configurable within what the vendor allows. | Your brand on the front end; the code and data stay on the vendor's platform under its terms. | Fast to moderate: configuration and branding. |
| Custom build | A scoped, phased build, then hosting and maintenance; no per-patient licence fee. | Designed in: each practice or partner organization can run as its own isolated tenant. | Generated from your own billing rules, in the format each partner expects. | You decide what is logged, by staff member, patient and month, and you hold the log. | Yours, including the source code on final payment. | Slowest: discovery, a written scope and a phased build come first. |
Custom is the slowest to start and only pays off when your workflow doesn't fit the other three, for example when you invoice many partner practices on your own terms or need each practice's data kept strictly apart.
CCM (CPT 99490) requires at least 20 minutes of clinical staff time per calendar month; PCM requires at least 30 minutes per month for a single high-risk condition. Two recent federal actions make the audit trail behind those minutes, and who does the work, more important. Source: CMS MLN909188, Chronic Care Management Services.
OIG audit announced
The HHS Office of Inspector General added an audit of Medicare Part B payments for chronic care management services furnished from 2019 through 2024, looking for payments at risk of noncompliance with the multiple-chronic-conditions requirement.
PROPOSED
CMS proposed that, from January 1, 2027, Medicare would pay for remote physiologic and therapeutic monitoring (RPM/RTM) only when the clinical staff are directly employed by the billing practitioner or practice. The proposal does not include CCM, PCM or APCM. It is not a final rule.
Engineering and operations context, not legal or billing advice. Confirm billing decisions with your compliance advisor. Last reviewed 2026-09-28.
Useful before a first call:
API backend, billing rules and role-based access enforced at the API layer
Schema-per-tenant isolation, row-level security and field-level encryption of patient identifiers
Coordinator, manager and administrator dashboards with role-conditional rendering
Monthly reports and invoices generated from CPT paycode counts
Common questions about operations software for care-management organizations
It depends on scope, so we don't quote a generic timeline. The first release targets your most painful manual workflow, such as minute tracking or month-end invoicing, and later phases build on it. You get the timeline with the written scope, after we have reviewed your spreadsheets and workflow in the free consultation.
Yes. We sign a Business Associate Agreement (BAA) before any PHI access: no one on our team sees protected health information until it is executed. We can sign your organization's BAA or provide ours, and the signed agreement governs. Our HIPAA BAA page explains when one applies and what ours covers.
Yes. Each partner organization can run as its own tenant: an isolated data environment (schema-per-tenant PostgreSQL with row-level security) with its own users and roles. That is how the platform in our case study works, and we design it in from the start when several organizations will share one platform.
You do: you own the source code on final payment, and your patient and billing data stay yours throughout. After launch you can keep working with us under a monthly retainer, bring development in-house, or hand the codebase to another team. The platform in our case study belongs to that client, not to us.
We start by mapping your spreadsheet columns to the new data model, then write import scripts that validate every row and report what could not be matched, such as duplicate patients or missing IDs, for your team to resolve. Imports are tested on de-identified or synthetic copies first wherever possible; real patient data moves only after the BAA is signed.
Our team works from Pakistan with overlap into US business hours. PHI access is controlled three ways: a signed BAA before anyone sees PHI, role-based access so each person sees only what their role needs, and audit logging of that access. During builds we use de-identified or synthetic data wherever possible to keep production PHI out of development.
Not as proposed. CMS's CY2027 proposed rule (CMS-1848-P) would limit RPM and RTM payment to clinical staff directly employed by the billing practice from January 1, 2027. It does not include CCM, PCM or APCM. It is a proposal, not a final rule; our RPM brief, linked on this page, tracks its status.
No. The EHR remains your clinical record. What we build is the operations layer beside it: rosters, minute tracking, monthly verification, coordinator workload, and partner-practice reporting and invoicing. Where your EHR or other systems expose an interface, we can integrate with them, as the case-study platform does with an external RPM system.
Deep-dive technical guides related to operations software for care-management organizations
Calculate how much you're spending on manual processes and how fast custom software pays for itself.
Calculate SavingsDownload a practical checklist of HIPAA Security Rule safeguards to review before you launch.
Get ChecklistRead the published CCM/PCM engagement: Excel to a multi-tenant platform serving 8,000+ patients.
Read the Case StudySchedule a technical consultation to discuss your specific requirements, timeline, and budget. No sales pitch—just engineering.
Or explore the engineering glossary to learn more about healthcare software terminology.
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