Across the group's Medicare panel, hypertension sits in 75.0% of patients, ischemic heart disease in 60.0%, diabetes in 39.4%, atrial fibrillation in 39.3%, chronic kidney disease in 36.4% and heart failure in 34.7% — at an average beneficiary age of 77.6. Every one of those qualifies a patient for remote physiologic monitoring, for principal care management, or for both. What is not established is what the practice's own "Remote Patient Monitoring Services" line already covers — and this page treats that as the first question, not as an assumption.
Source: the companion CoachCare Value Analysis workbook, MAC locality FL • 09102-04. Every figure on this page is the fee-for-service case. Miami-Dade County is 75.2% Medicare Advantage — only about one in four local Medicare beneficiaries is in traditional fee-for-service — and the plan book is additive and unpriced. That qualifier is set out in full in the next section, not in a footnote.
This practice does not need convincing that between-visit data changes cardiac outcomes: it already runs supervised, device-collected remote care in cardiac rehabilitation, and it has repeatedly bought and deployed new clinical technology. What no public source establishes is what the practice's advertised remote-monitoring line item actually covers today. So this page prices the opportunity, states the qualifier, and puts the question first.
37 physicians and 6 advanced practice providers enrolled under the group's own organizational identifier: 28 cardiovascular disease, 4 interventional, 3 electrophysiology, 1 advanced heart failure and transplant, 1 internal medicine, 5 nurse practitioners and 1 physician assistant, across 9 PECOS practice addresses. 34 of the 43 carry the telehealth indicator. Because all 43 reassign to the group, the professional fee on these services lands on the practice's own statement.
Beneficiary-weighted across the practice's Medicare panel: hyperlipidemia and hypertension 75.0%, ischemic heart disease 60.0%, diabetes 39.4%, atrial fibrillation 39.3%, chronic kidney disease 36.4%, heart failure 34.7%, COPD 26.0%, stroke or TIA 20.0% — at a mean beneficiary age of 77.6. This is the clinical profile where remote monitoring and care management have the strongest evidence base.
The practice's billing entity is a confirmed participant TIN in an accountable care organisation on the Enhanced track — two-sided, maximum risk — continuously operating since 2012, with 823 participant TINs and retrospective assignment. Retrospective assignment means the attributed panel cannot be pre-identified, which raises the value of broad, low-friction chronic-care enrolment rather than narrow targeting.
The services page lists "Remote Patient Monitoring Services" as a bare line item. The expected page returns not-found; no workflow, conditions, devices, vendor or enrolment path is described. A programme running today would be entirely consistent with the public record — and would change this from a build to an extension, which is a better conversation, not a worse one.
The hard part of a remote care programme is not the technology. It is the operating habit — enrolment throughput, an alert-review protocol, a documented escalation standard, complete code capture, and clinicians who act on data arriving between visits. This practice already runs a live home-based cardiac rehabilitation programme with live video supervision and device-collected heart rate, ECG, blood pressure and oxygen saturation, alongside a walk-in immediate cardiac care clinic opened in September 2025 and an AI cardiovascular-laboratory initiative announced in March 2026. The instinct and the appetite are demonstrably here. The reimbursed, whole-panel layer is the open question.
Miami-Dade is one of the most Medicare Advantage-saturated counties in the United States. The consequence is favourable on scale and unfavourable on pricing, and both halves have to be said.
CMS Medicare Monthly Enrollment, CY2025 annual (dataset modified 2026-07-23, retrieved 2026-08-03). For comparison: Florida runs 56.7% and the nation 50.9%, so Miami-Dade sits roughly 24 points above the national figure. The practice's Broward sites sit at 64.7% and its Palm Beach site at 47.8% — three genuinely different payer markets inside one group.
Federal rules require a Medicare Advantage plan to pay a non-contracted provider no less than the amount the provider would have received under original Medicare. That is a genuine statutory floor, and it is the reason a Medicare Advantage panel should never be assumed to be worth less than a fee-for-service one.
That the floor settles what a contracted provider is paid for these particular services. For a contracted provider the rate is a term of the negotiated agreement — and so is the logically prior question: whether remote monitoring and care management are separately payable at all, or whether they are folded into a capitated, delegated or otherwise bundled arrangement in which someone else is already at risk for the same work.
Every figure on this page is a fee-for-service figure at MAC locality 09102-04. The Medicare Advantage book is larger and is priced contract by contract. It is treated here as additive and unpriced, and it should stay that way until the contracts are read. That reading is a first-order budgeting task and it belongs in the first 30 days.
New code 99445 pays the monthly device-supply amount for 2–15 days of data where 16 or more days were previously required, and 99470 pays for the first 10 minutes of monthly management time where the floor had been 20. Together they make short post-discharge and post-procedure windows cleanly billable for the first time.
That matters here specifically. This practice publishes a substantial structural-heart, electrophysiology and device-implant service list — every case of which opens exactly such a window.
The practice's billing entity is a verified participant TIN in an accountable care organisation running on the Enhanced track — full downside exposure — and has been in continuous operation since 2012 across 823 participant TINs. Retrospective assignment means the attributed panel cannot be identified in advance.
That combination argues for broad, low-friction chronic-care enrolment rather than narrow targeting of a pre-identified list: the patients who determine the reconciliation are only knowable afterward, so the programme has to cover the panel rather than a shortlist. A remote care service line is the cheapest way to do that at scale.
No mandatory model exposure — pure-upside timing, and prepared if selection maps change.
Everything in the forecast below is standalone recurring professional-fee revenue. It depends on no reconciliation, no shared-savings determination and no model performance year. Whatever the accountable care organisation returns, and whatever future CMS selection maps do, sits on top of it rather than underneath it.
A named service line with its own owner, P&L and scorecard, following the Medicare patient from the hospital bed back into the practice and then across the year. Built once, it is reused for every lever the group already cares about — rather than bolted onto a single condition.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use | In the model? |
|---|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200 / ~$280 | Every heart failure and post-procedure discharge from the practice's principal admitting hospitals | No — upside |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 unlocks the 2–15-day post-discharge and post-procedure window | Yes |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, titration, escalation | Yes |
| Principal Care Management | 99424 · 99425 · 99426 · 99427 | ~$60 + ~$50 add'l | Single high-risk cardiac condition expected to last ≥3 months | Yes |
The Value Analysis below uses CY2026 rates auto-resolved by MAC carrier and locality for zip 33180 — FL • 09102-04 — not these national figures, and every one of them is the fee-for-service case in a 75.2% Medicare Advantage county.
The same infrastructure — enrolment, devices, alert triage, escalation, documentation, billing capture — powers each thing the group already cares about.
Selecting a technology platform and operating a fully-billed service line are different achievements, and the gap between them is where most remote-care programmes underperform their business case. The checklist below is written to be applied to any option — an existing arrangement, a network-level arrangement, or this one. It is a checklist rather than a comparison, and the right way to use it is to walk it row by row against whatever is in place today.
| Requirement | Why it decides the outcome | How to test it |
|---|---|---|
| Enrolment labour physically present | Census is revenue, and census is built by a human having a conversation. A portal invitation, a mailer, or a task added to existing clinic staff does not produce the modelled enrolment rate. | Ask how many enrolments per month, by whom, physically located where, across how many of the ten offices — and who pays for that person. |
| The complete billing stack, not one code family | A programme that bills 99454 and stops leaves 99453, 99445, 99457, 99470, 99458 and the whole of 99424–99427 on the table. The modelled economics assume the full stack is captured. | Ask for a code-level capture report: billed units by code, by month, against eligible patient-months. |
| Clinical governance owned by this practice | Alert thresholds set by vendor defaults rather than by the practice's own physician lead produce either alarm fatigue or missed deterioration. Escalation has to end with a named clinician in this practice. | Ask who sets the thresholds, who receives the escalation, what the response-time standard is, and what happens at 2 a.m. on a Sunday. |
| Documentation that survives an audit | These are time-based and day-count-based codes. Documentation that cannot evidence the minutes and the days is a recoupment risk, not a revenue line. | Ask to see a de-identified example of the record generated for a single billed patient-month. |
| Automated claim generation | Manual capture degrades across 43 clinicians and ten sites, and it degrades silently — the census keeps growing while the capture rate quietly falls. | Ask whether claims are generated from the monitoring record, or assembled by a person at month end. |
| Structured reporting back to referring physicians | It is the referral-retention artifact and the attribution-policy enforcement mechanism at the same time. | Ask what the referring physician receives, in what format, and how often. |
| Payer segmentation and reporting | In a 75.2% Medicare Advantage county, a census that cannot be segmented by payer cannot be managed or forecast — and the Medicare Advantage rate question cannot even be measured. | Ask for the census and code-capture report broken out by payer type. |
| The professional fee lands on this practice's statement | This one is true under any arrangement — remote monitoring, principal care management and transitional care management are physician professional services billed under the practice's own tax identification number. It is worth confirming explicitly nonetheless, because it is the row that determines whose profit-and-loss statement the programme improves. | Confirm the billing entity, the supervising-physician arrangement, and the revenue flow in writing. |
The reason to run this test rather than a feature comparison is that every row of it is an operational commitment rather than a software capability. Software is rarely the reason a remote-care forecast is missed; enrolment throughput, incomplete code capture and documentation quality are. A practice that walks this checklist before committing gets a better programme regardless of which way the decision goes — and CoachCare expects to be measured against every row of it.
Your staff do not learn a second system. Enrolment flags, discrete vitals, escalation tasks, compliance documentation and claims live inside athenaOne — and CoachCare is the only care-management partner that generates athenahealth claims automatically. This is not a directory inference: the practice's own athenahealth patient portal instance returns a live, branded page and is linked from the global navigation of every page on the practice website (verified 2026-08-03).
Qualified Medicare patients are enrolled by CoachCare's team, prompted by enrolment flags and trigger ordering by service. Enrolment status is visible in real time in the clinical workflow the practice already uses, and patients begin receiving services in under five days.
The CoachCare billing engine creates claims automatically, eliminating the manual per-patient, per-month step. Across 43 clinicians and ten sites, that is the difference between a capture rate that holds and one that degrades silently while the census keeps growing.
Clinical escalations arrive as tasks in the system your physicians already work in, routed to the person you designate — not as email, and not as a separate portal login nobody opens.
Confirm in contracting athenahealth integration setup and per-patient integration fees are carried inside the Value Analysis fee line at catalog rates; exact figures are confirmed in contracting. Whether an electronic health record standardisation is planned above the practice is not established from any public source — athenahealth practice context 1931 is live and branded as of 2026-08-03, so the practice is on athenahealth today, but an in-flight migration would be a material integration risk for any remote-care deployment and is worth asking about directly.
The economics prove the service line pays. This proves it is safe and disciplined. Every reading a patient takes routes through one shared escalation engine with defined thresholds, defined trends, defined routing and a defined documentation standard — so the practice receives signal, not noise, and never carries surveillance liability it did not agree to. A group that already supervises remote cardiac rehabilitation sessions will have strong, well-earned opinions about alert triage. That is the right conversation to have, and this is the floor it starts from.
Both programmes in this service line — remote physiologic monitoring and principal care management — route through the same logic. The engine is programme-agnostic; the thresholds are set with the practice.
A reading at a critical threshold escalates regardless of whether the patient reports symptoms. There is no "wait and see" branch on a critical value, and no client preference can suppress it.
A non-critical out-of-range reading is worked rather than forwarded: confirm technique, retake, then run a structured symptom check. Most out-of-range readings resolve here — which is why the practice's inbox stays clean.
An out-of-range trend is not a judgement call. It is three consecutive readings at least one hour apart for blood pressure or glucose, or three readings within seven days for heart rate. A confirmed trend escalates on the same footing as a threshold breach.
If the patient cannot be reached, the attempt is documented, a voicemail and callback request are left — and if the reading was critical or a confirmed trend, the escalation proceeds anyway. Silence never downgrades a clinical finding.
Six fields, every time, so the record is auditable and any event can be reconstructed end to end.
Triggered automatically by any emergency-room visit or hospitalisation reported in the last 60 days. This is the readmission-prevention spine — and the mechanism behind the 447 hospitalizations avoided in the forecast below. It matters here specifically: the practice's main office sits inside one of its principal admitting hospitals' campuses, and a 34.7% heart-failure panel at a mean age of 77.6 generates exactly the discharges this cadence is built for.
Confirm the patient is home and safe, reconcile discharge medications against what is actually in the house, verify follow-up appointments exist, and confirm the monitoring device is set up and transmitting. Clinical alerts documented and escalated per the engine above.
The window where post-discharge decompensation typically declares itself. Symptom review, weight and blood-pressure trend review against the readings already flowing in, adherence check, and escalation on any confirmed threshold or trend.
Confirm the follow-up visit happened, close open issues, verify the patient understands the escalation path, and hand the patient into the longitudinal monitoring panel so the 30-day window closes with continuity rather than a cliff.
Patients do not silently fall out of the programme, and the practice is notified at every decision point.
A patient who stops responding is escalated to the practice first, then re-escalated every 30 days — not quietly dropped and not left accruing.
If no instruction is received from the practice, discharge proceeds at 180 days. The clinic is notified in every case, and discharges generally process in the first week of the following month.
Clinical discharge criteria, escalation thresholds and routing are the practice's to set. CoachCare executes them consistently and documents the execution — it does not overrule clinical judgement, with the single exception of the emergent floor above.
Because every escalation carries the same six documented fields, any episode can be reconstructed end-to-end — which is what a full-downside accountable care organisation and a serious hospital relationship both actually require.
A 24-month forecast for a two-programme service line — remote physiologic monitoring and principal care management — across 43 referring providers, one CoachCare-funded on-site enrolment specialist, and CY2026 rates auto-resolved for MAC locality FL • 09102-04. Transitional care management revenue, avoided-admission savings, accountable-care shared savings, procedural throughput and the entire Medicare Advantage book are not in these numbers. They are upside on top.
| Line | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $1,720,602 | $5,248,989 | $6,969,591 |
| PCM net reimbursement | $531,138 | $1,661,108 | $2,192,246 |
| Total net reimbursement | $2,251,740 | $6,910,097 | $9,161,837 |
| CoachCare fees | $1,302,691 | $3,978,690 | $5,281,381 |
| Practice net (after fees) | $949,049 | $2,931,407 | $3,880,456 |
| Practice margin | 42.15% | 42.42% | 42.35% |
| Includes one on-site enrolment specialist staffed at CoachCare's expense — embedded value already reflected in the fees above, never a deduction from practice margin. | |||
Month-1 practice profit is $2,161 and the first profitable month is month 1. All of it is the fee-for-service case at locality 09102-04; the Medicare Advantage book is additive and unpriced. The full model is available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months — on top of the existing procedural, device and imaging book, not instead of it.
A continuous clinical picture of the heart failure, hypertension, rhythm and renal-cardiac panels between visits — the whole-panel twin of the device data the practice already reviews.
Roughly $6.7M of avoided acute cost at $15,000 per admission.
71,366 care-team hours of monitoring, outreach, escalation and documentation carried by the service line rather than by practice staff, across ten sites in three counties.
Every input below is an assumption, and every assumption is arguable. Move them and the 24-month forecast recomputes live. At the modelled settings this engine reproduces the companion Value Analysis workbook exactly — so any disagreement you have with the output is really a disagreement with an input, which is a much more productive conversation.
"Enrolled services" counts active programme enrolments; a patient enrolled in both programmes counts twice. At month 24 the model's 7,236 enrolled services correspond to 5,962 unique patients once dual enrolment is deduplicated.
CoachCare operates the engine — enrolment outreach, device logistics, 24/7 monitoring, escalation and billing-ready documentation — while the practice's physicians govern the protocols and make every clinical decision. Full-service delivery means launch requires no new practice headcount, and the on-site enrolment specialist in the model is funded by CoachCare.
Establish what "Remote Patient Monitoring Services" covers today, and pull the Medicare Advantage contracts to answer whether these code families are separately payable, at what rate, and whether any part of the panel is delegated or capitated. In parallel: name a service-line owner with a P&L and a scorecard, confirm the billing configuration for MAC locality FL • 09102-04 — and confirm the locality assignment for the Broward and Palm Beach addresses separately — and agree the escalation matrix and discharge criteria.
First, the heart-failure cohort the practice can already see — 34.7% of the Medicare panel, with a dedicated advanced heart failure and transplant sub-specialist and an amyloidosis imaging pathway already identifying the phenotype. Second, post-discharge patients from the principal admitting hospitals, on the three-touch cadence with short-window RPM placed at discharge. Target the first billable enrolment inside 90 days.
South Miami, Kendall, West Kendall, Aventura, Coral Gables, Coconut Grove and Miami Lakes covered by the on-site specialist in rotation; Fort Lauderdale and Boca Raton carried by the telephonic pathway. Longitudinal RPM and PCM panels running under protocol, with a monthly scorecard — census, code-level capture rate, revenue per patient-month, escalation volume, readmission signal — segmented by payer type, reporting to practice governance.
Twelve months in, walk the eight-row checklist against the programme as actually delivered — enrolment throughput, code-level capture across the full stack, documentation quality, referring-physician reporting and payer segmentation. That is the discipline that keeps a remote-care forecast honest, and it is the same instrument this page proposes applying to every other option.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for more than 500,000 patients.
Providers running remote care programmes on the platform.
Remote care programmes implemented and running.
Care plan coding and billing generating over five million claims.
Over 100 million vitals and more than four million care actions recorded.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how the operating model behind this service line absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That distinction lands directly on this forecast — PCM carries $2,192,246 of the modeled $9,161,837 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the service line's economics hold wherever the rule settles. One unbundles the program into its parts — SaaS platform, device logistics, and program enablement — priced as components. Another engages CoachCare to run the staffing itself, an MSO-style arrangement in which the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is among its four clinical tracks. What earns under that structure — controlled pressures, titrated therapy, decompensations caught early — is what this service line is built to produce.
This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality rather than national averages. Same enrollment, same phasing plan — only the rates move.
Both bars run on the same dollar scale, so the red slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the care-management revenue RPM alone does not include.
Repriced at this locality's own geographic adjusters. The RPM reductions fall almost entirely on practice expense, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be −8.8% on RPM. Of the $575,631, RPM accounts for $559,435 and the care-management arm for $16,196.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99424–99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those families moves within about 4% in either direction, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, and CMS publishes the affected codes, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.