Nem's Care Management module runs the programs that pay for care between visits: Chronic Care Management (CCM), Principal Care Management (PCM), Advanced Primary Care Management (APCM), Transitional Care Management (TCM), Remote Physiologic Monitoring (RPM), Remote Therapeutic Monitoring (RTM) and Behavioral Health Integration (BHI).

The module is built around one idea. The paperwork that makes a care management claim defensible should be produced as a side effect of doing the work, not reconstructed at the end of the month.

Enrolment

A patient moves through an explicit lifecycle, from referral and eligibility through consent, enrolment, active monitoring and billing, with paused, discharged, completed and renewed states along the way. There is also an entered-in-error state for an enrolment opened by mistake, which frees the program for a clean re-enrolment. Every transition is appended to a history that is never overwritten.

Programs that cannot be billed together are blocked at enrolment rather than discovered at month end. CCM and PCM are mutually exclusive. So are RPM and RTM. APCM cannot run alongside CCM, PCM or TCM.

Consent

Consent is recorded before the program starts, with the method used, the clinical date, who obtained it, and the acknowledgements CMS requires. Nem stores a copy of the exact version of the consent script that was read, so editing your script later never changes what a past patient was told.

The server refuses to record consent at all without the copay and right-to-stop acknowledgements. Revoking consent requires a reason, and revocation never deletes the record.

Care plans

A coordinator builds the care plan in a wizard that can be saved as a draft and picked up later. Choosing a condition prefills problems, goals, interventions, outcomes, barriers and symptoms from a seeded clinical library. The screen tells the coordinator which tier of the library the prefill came from rather than hiding it, so nobody mistakes a broad fallback for a condition-specific plan.

When the plan is finalized Nem keeps an immutable snapshot of it. Later changes are recorded as a plain-English update history, and a condition can be replaced without losing what came before.

Logging time

Staff log time against a care plan for each activity, in seconds, attributed to the person who did the work. From each entry Nem derives whether the time was clinical and whether it involved live interaction with the patient, because the billing rules depend on both.

Two things are worth knowing:

• Duration is entered, not measured. There is no start and stop timer.
• The work type you choose drives the billing derivation. A patient call logged under some other work type can quietly cost you a code.

Stage gates

Before an enrolment advances, Nem checks a set of requirements. Your organization can set each one to block, warn, or require an attestation from a named person.

One check cannot be overridden by anybody. Staff located outside the United States cannot be added to a care team, cannot be brought onto one, and cannot be billed for, because 42 CFR 411.9 does not allow it. No attestation overrides that, and the reporting shows you the difference it makes.

Month end

In the first days of each month Nem sweeps the month just finished. It uses each clinic's own local calendar month, so a clinic in another time zone is never billed against somebody else's month, and daylight saving does not move the boundary. A clinic that fails never stops the others.

The sweep produces one reviewable line per patient per month. Your biller has three actions on a line: run the sweep, approve, or reject with a reason. Re-running the sweep never disturbs a line that has already been approved, rejected or exported. Approved lines export as a CSV charge file, and that export is logged as a disclosure before any data leaves.

The readiness indicator, and why it is worded carefully

A green line reads "No conflict visible to Nem". It does not read "Ready", and it carries its own limitations on its face. That wording is deliberate, and this is what it means.

• Nem cannot tell you the patient is covered. There is no real-time eligibility check and no claims submission. Coverage status is whatever your staff typed in.
• Nem cannot tell you another practice has not already billed this patient this month. CMS allows one practitioner per patient per month and enforces it by the order claims arrive. Nem can only see conflicts inside your own organization.
• Nem cannot tell you the exact payment. Rates are seeded national estimates. They are not adjusted for your locality and have not been checked against the current fee schedule. Where no rate exists Nem shows nothing rather than zero.

What is not built yet

• Automatic device readings for RPM and RTM. The billing engine is complete and correct, including the sixteen day threshold, but there is no device integration and no way to register a device in the product. Today a reading reaches Nem only when a staff member types it in, and CMS requires device data to be collected and transmitted automatically, so a typed reading does not support a device-day claim.
• Complex CCM (99487 and 99489), and the dual-eligible APCM tier. Nem leaves these unbilled rather than guessing. That under-bills on purpose, which is the safe direction in an audit.
• A discharge feed for TCM. The discharge date, location and decision-making level are entered by a person, and there is no automatic deadline alert.
• Bulk or campaign outreach to a group of enrolled patients.

What you get back out

Care time and revenue split by who logged the minutes, a coordinator productivity report with no money in it so supervisors can be shown it, minutes-to-threshold lanes showing who is close and who will miss, enrolment by program and state, care value by code and by program, and a printable care plan report covering exactly the same period the sweep uses.