Care Time and chronic care management

Care Time has three parts in Ona: practice setup in Care Plans, patient-level logging and enrollment in a patient's Care Time page, and month-end review in the main Care Time page. Clinicians can log their own time. Owners, admins, and staff can also enroll patients and close the month. Logging time and being able to bill it are two different things, and the gap between them only shows up at close.

How do I turn on Care Time?

In the left sidebar, click Settings. In the settings menu, under Care, click Care Plans to turn on care-management tracking for the practice. Only owners and admins can change these settings.

Use Settings (1) to open the settings area, then Care Plans (2) to open the page that controls practice-wide care-plan and Care Time settings.

Use Care Plans settings (1) to stay on the Care Plans page, Chronic Care Management (2) to find the section with the Care Time controls, and Track care-management time (3) to turn Care Time on.

1. In the left sidebar, click Settings. In the settings menu, under Care, click Care Plans.
2. In Chronic Care Management, turn on Track care-management time.
3. Set Minimum billable minutes for the calendar-month threshold your practice uses.
4. Set Place of service code for the two-digit CMS place-of-service code that should go on CCM claim lines.

Changes save on this page as you make them. If you have not changed them, Minimum billable minutes starts at 20 and Place of service code starts at 11.

One quirk to know: neither field shows a validation error. Type something that is not a whole number, or a place-of-service code that is not two digits, and it simply is not saved — the previous value stays. Reload the page if you want to be certain what stuck.

Before you bill anything, set amounts for your CCM codes in Fee Schedule. To get there, in the left sidebar, click Settings. In the settings menu, under Billing, click Fee Schedule. If a billed CCM code has no active fee schedule entry, the close can block that patient. For fee schedule setup, see Fee schedules.

How do I log care-management time for a patient?

In the left sidebar, click Patients, then open the patient. In the patient sidebar, under Billing, click Care Time to log work done between appointments. You can also start the same timer from an open visit: in the left sidebar, click Visits, open the visit, then use the care-time dock at the bottom of the screen.

1. Open the patient's Care Time page.
2. To add time without a timer, click Log time.
3. To time work as you do it, click Start in the care-time dock at the bottom of the screen, then click Stop & Log when you finish.
4. In Log care management time, choose Activity, enter Minutes, and set When only if you need to backdate the work.
5. If Whose time is shown, choose the member whose work you are logging.
6. Add a Note, then click Log time.

The entry is saved to the patient's month and appears in the entries list.

A few fields matter more than the rest:

• Activity changes reporting. It does not choose the price.
• Minutes must be whole minutes from 1 to 480.
• When can be left blank for now. If you enter a future date, the field shows “Can't be in the future.”
• Whose time is available to owners, admins, and staff to choose the member whose work they are logging. Clinicians log only their own time.
• The billed-as panel is not editable. It is derived from the selected member's role and decides which CCM code ladder the minutes are priced against.

If you start the timer from a patient or visit, the same dock follows you across the dashboard until you log or discard the time. A recent refresh restores a running timer. An older running session comes back paused so it does not keep counting while you were away. Stop & Log fills the dialog with rounded whole minutes, with a minimum of one minute. Closing the dialog does not save the time, and the timed session is cleared only after the entry is saved. If you discard a running timer, Ona asks you to confirm with Keep timing or Discard.

Billing periods follow your organization's timezone. If no timezone is set it falls back to UTC, which can push a late-evening entry into the next month. To review that setting, in the left sidebar, click Settings. In the settings menu, under Practice, click Organization.

How do I see whether a patient is billable this month?

In the left sidebar, click Patients, open the patient, and under Billing click Care Time to review the current month's progress before closing billing.

Use the Billable minutes (1) summary to see the total for the month against your practice threshold. Read the Staff and clinician split (2) as carefully as the total, because staff time and clinician time are priced on separate CCM ladders. Use the Entries list (3) to review what was logged and whether an entry is marked Claimed, Voided, or Not billable.

The page can show Threshold met when total minutes clear your organization's minimum and still fail cleanly at close. That happens when minutes are split across roles and neither role reaches a code on its own. For example, 15 staff minutes and 15 clinician minutes clear a 20-minute practice threshold, but neither role reaches its own CCM rung. Read the split, not just the total.

Time totals count only non-voided, billable entries. Voided and non-billable entries stay visible as history, but they do not count toward the month's billable total.

How do I enroll a patient in chronic care management?

In the left sidebar, click Patients, open the patient, and under Billing click Care Time to enroll the patient on their active care plan. Owners, admins, and staff can enroll or unenroll. Clinicians cannot.

Time can be recorded before enrollment, but it cannot be billed until the patient is enrolled.

1. Open the patient's Care Time page.
2. In the enrollment card, click Enroll.
3. In Enroll in care management, choose a Signed consent.
4. If you want to record the responsible clinician, choose a Designated practitioner.
5. Click Enroll.

After the save, the card changes to Enrolled in care management.

Enrollment needs two things:

• An active care plan. If there is no active plan, the page says the patient needs one before they can be enrolled, though time logged now still counts once they are.
• A signed consent whose type is Care Management. If none is available, the dialog shows No signed CCM consent yet and offers Go to Consents.

The stock Chronic Care Management Enrollment consent in the consent library covers the required attestations, including the single-practitioner acknowledgement and cost disclosure.

Designated practitioner is optional and recorded for documentation.

Enrollment belongs to the active care plan, not to the patient as a whole. The monthly close reads the active plan only. Ending a plan ends the enrollment, and the replacement plan starts unenrolled. If you replace or rebuild a patient's plan, re-enroll them on the new active plan. For help creating plans, see Building care plans.

How do I unenroll a patient from chronic care management?

In the left sidebar, click Patients, open the patient, and under Billing click Care Time to stop billing future Care Time on the active plan.

Review the Enrollment status (1) area first so you know which active plan is enrolled. Then use Unenroll (2) to stop billing Care Time on that plan.

1. Open the patient's Care Time page.
2. Confirm the card shows Enrolled in care management.
3. Click Unenroll.

After the save, the card returns to Not enrolled in care management.

Unenroll is the clinic's side only. It stops the billing; it does not withdraw the patient's consent, which is theirs to revoke.

What do staff time and clinician time bill to?

In a patient's Care Time page and in the main Care Time close preview, Ona keeps staff time and clinician time separate because they bill to different CCM code ladders.

Owners, admins, and clinicians log on the clinician ladder. Staff-only members log on the staff ladder. When owners, admins, or staff use Whose time to log for someone else, the selected member's role is what matters.

Code	Who it applies to	When it starts	Add-on rule
99490	Staff time	20 minutes	Base staff CCM code
99439	Staff time	40 minutes	One unit per further 20 minutes, capped at 2 units
99491	Clinician time	30 minutes	Base clinician CCM code
99437	Clinician time	60 minutes	One unit per further 30 minutes, capped at 2 units

So 25 staff minutes bills 99490 alone; 45 bills 99490 plus one unit of 99439; 100 still bills 99490 plus two units, because the add-on caps.

Only one base code can be billed per patient per month. When both role ladders qualify, Ona bills the clinician code and flags the result Both roles qualified — review. The close result also explains: only the clinician code was billed, and the staff minutes were still marked claimed.

These thresholds reflect the long-standing CCM structure and are a starting point. Verify them against the fee schedule for the year you're billing.

How do I close a month into draft CCM claims?

In the left sidebar, under Admin, click Care Time to review unbilled time and close a billing period. Owners, admins, and staff can use this page. Clinicians cannot.

Use Billing period (1) to switch to the month you want to review. The Unbilled time area (2) shows which patients still have minutes left to bill. Run preview (3) checks the period before you close it, and Close period (4) drafts the claims when the preview shows at least one claimable patient.

1. In the left sidebar, under Admin, click Care Time.
2. Choose the month in Billing period.
3. Review Unbilled time to see which patients still have minutes left to bill.
4. Click Run preview.
5. Review the preview results and fix any blocked rows using Enroll, Care plan, Consents, or Fee schedule.
6. When the preview shows at least one claimable patient, click Close period.
7. In the confirmation dialog, click Close period again.

Ona drafts insurance claims and marks the underlying time Claimed so it can no longer be voided or edited. These are draft insurance claims — not invoices, not superbills. The close creates one claim per patient, dated the last day of the period, carrying up to four diagnosis codes taken from the plan's health concerns and a service line per resolved CPT code. From there, they are ordinary draft claims. See How claims move through Ona.

Two close rules matter:

• Run preview is required first. You cannot close for real until you have previewed the period.
• The real close unlocks only when the preview found at least one claimable patient.

The page defaults to the previous month. Ona also runs the monthly close automatically at 03:00 UTC on the 2nd for the previous month. Anything blocked on the page is skipped by that automatic run until someone fixes it. Closing twice is safe. Patients already claimed come back as skipped and nothing is written.

What blocks a close?

In the left sidebar, under Admin, click Care Time, then click Run preview to see why a patient was claimed, skipped, blocked, or failed.

Common reasons include:

• “Patient has no active care plan” — create and activate a care plan.
• “Patient is not enrolled in CCM” — enroll the active care plan.
• “No signed, in-effect CCM consent for this period” — send or collect the right Care Management consent.
• “No fee schedule entry for 99490” — add the missing fee schedule amount.
• “Below the 20-minute threshold” — skipped, not blocked. There was not enough time for the month.
• “This period has already been claimed” — skipped. That patient's month is already closed.

Blocked rows sort to the top of the preview so the patients you can still fix are the first ones you see.

That last skip has a sharp edge. If time is backdated into a month after that patient was already claimed for the month, it sits there unbilled. The period cannot be reopened, and a re-run reports the patient as already claimed. If you know time is still coming in, close later rather than twice.

What can't I do here?

Care Time is limited in these ways:

• Staff and clinicians cannot change practice-wide Care Time settings in Care Plans.
• Clinicians can log their own time, but they cannot use the main Care Time page to close a billing period.
• Clinicians cannot enroll or unenroll patients in care management.
• On an archived patient's chart, Log time, Enroll, Unenroll, and Void entry… are disabled.
• A visit for an archived patient does not offer a Care Time timer.
• A single time entry must be whole minutes from 1 to 480.
• You cannot log a future date in When.
• You cannot close a period for real until you have run Run preview first.
• You cannot close a period for real if the preview found nothing claimable.
• Claimed time is frozen. Once time is on a claim, it cannot be voided or edited from Care Time.
• A closed period cannot be reopened.

Common questions

Does logging time enroll the patient?

No. Logging time and enrolling the patient are separate. Time can be recorded before enrollment, but it cannot be billed until the patient is enrolled.

What does Both roles qualified — review mean?

It means both the staff ladder and the clinician ladder qualified for the month. Ona bills the clinician code and still marks the staff minutes claimed, so that row is worth reviewing.

Can I remove a time entry?

Not by deleting it. Before the month is claimed, use the entry's ⋯ menu and choose Void entry…, then enter a Reason. The entry stays in history as Voided. Voiding cannot be undone, and claimed entries no longer show the row action menu.

What happens if the patient changes care plans mid-month?

A mid-month plan switch splits the patient in two, with each plan checked against the threshold on its own. Fifteen minutes on the old plan and fifteen on the new plan still bills nothing.

What happens if the patient withdraws Care Management consent mid-month?

That month is still billable, and later months are not.