A newly independent cardiology group with seven physicians, three nurse practitioners and a Medicare panel of about 8,000 is building its operating model from a clean sheet. This is the case for making remote care part of that founding model: transitional care at every discharge, remote monitoring and principal care management for the months after, staffed and run by CoachCare inside Epic, with no capital and no new hires. The line is positive from month 2, and the practice keeps 42.6% of net reimbursement over 24 months.
Year 1 margin 41.67%, Year 2 42.91%. Enrollment begins in month 1; month 1 runs −$4,648 while setup posts against a small census, and the practice is positive from month 2 onward. The headline is 1,924 unique patients; the enrollment chart shows 2,493 active program enrollments, because a patient on both programs is one patient and two enrollments.
The group is weeks old as a business and years old as a clinical practice. Its physicians arrive with established panels, established referral relationships and the habits of a large cardiology service. What they do not yet have is a billing operation with anything in it beyond the office visit. That is the opening.
Six cardiologists, one electrophysiologist and three nurse practitioners, formerly part of a Phoenix health system, now at one office on North 12th Street. Roughly two patients in three are Medicare, and in Maricopa County about half of Medicare is Medicare Advantage (51.5%). The electrophysiology practice already reviews remote device transmissions on a calendar, which is the habit this service line is built on: an incoming data queue, worked on a schedule, documented and billed.
A new tax identification number and a billing operation that is being stood up now. Everything the group has to build anyway to run a care-management program, enrollment, consent, care-plan documentation and a monthly billing rhythm, is what CoachCare runs. Remote care launches as part of the founding operating model rather than as a retrofit onto one.
A cardiology patient with heart failure or atrial fibrillation is seen every three to six months. In the months between, the weight trend, the blood pressure, the medication titration and the phone calls are unmonitored and unpaid. On a panel of 8,000 Medicare patients, that is most of the year for most of the panel, and it is where 99453 through 99458, 99470 and 99426/99427 apply.
Maricopa County carried 801,802 Medicare beneficiaries in 2025, and as of September 2026 51.5% of them are in Medicare Advantage. Medicare Advantage plans reimburse at or above the Medicare rate as a floor; individual contracts set their own terms for the care-management code families. The forecast on this page is priced at the Medicare rate throughout.
The commercial and AHCCCS third of the panel sits outside the forecast, and Arizona is a friendlier state for it than most. AHCCCS covers remote patient monitoring, including the CY2026 codes 99445 and 99470, with the professional service billed by the AHCCCS-registered provider and the device under its medical-supply policy. Arizona's commercial parity statute defines telehealth to include remote patient monitoring, so a commercial denial on "telehealth" grounds is weak here. Both are scoped separately once the Medicare line is running.
The thirty days after a cardiac discharge are where a readmission is decided, and they are the days this service line is built around: contact within two business days, a visit inside 7 or 14 days, a cuff and a scale transmitting daily, and a nurse who sees a three-pound weight gain on Tuesday and has the diuretic adjusted before Friday. Every hospital that admits these patients is scored on that window. A cardiology group that runs the cadence becomes the referral relationship those hospitals want more of, and it starts the practice's own outcome record on day one.
At a 20% annual admission rate across the monitored census. A cohort where half the patients carry heart failure admits well above that; at 40% the figure is about 322.
At $15,000 per admission. None of it is in the Value Analysis below, which prices the fee-for-service codes only.
The same census, the same program, an admission rate closer to what a heart-failure cohort runs. The practice's own discharge data replaces both figures once the program is live.
Three billing families, one clinical workflow, one care team. A patient enters wherever they are, coming out of the hospital, newly decompensated, or overdue for real between-visit management, and stays on the same pathway.
Noridian, Arizona statewide locality 03102-00, non-facility. Arizona has one fee-schedule locality, so every office in the state prices the same.
| Code | What it covers | CY2026 rate | Cadence |
|---|---|---|---|
| 99496 | Transitional care management, high complexity, face-to-face within 7 days | $292.37 | Once per discharge |
| 99495 | Transitional care management, moderate complexity, within 14 days | $215.45 | Once per discharge |
| 99453 | Remote monitoring, patient set-up and education | $20.96 | Once per episode |
| 99445 | Device supply, 2–15 days of readings (new for CY2026) | $50.45 | Short window |
| 99454 | Device supply, 30 days of readings | $50.45 | Monthly |
| 99470 | Monitoring management, 10–19 minutes (new for CY2026) | $25.49 | Monthly |
| 99457 | Monitoring treatment management, first 20 minutes | $50.65 | Monthly |
| 99458 | Monitoring treatment management, each additional 20 minutes | $40.61 | Monthly |
| 99426 | Principal care management, clinical staff, first 30 minutes | $66.47 | Monthly |
| 99427 | Principal care management, clinical staff, each additional 30 minutes | $52.98 | Monthly |
| 99424 | Principal care management, physician or other qualified professional, first 30 minutes | $85.88 | Monthly, when the physician does the time |
| 99425 | Principal care management, physician or other qualified professional, each additional 30 minutes | $60.32 | Monthly, when the physician does the time |
CY2026 Physician Fee Schedule non-facility amounts for ZIP 85006 (Noridian JF, Arizona statewide locality), the basis the Value Analysis below is priced on. The forecast bills the clinical-staff PCM codes; the physician codes are listed for the months a cardiologist personally carries the time.
CoachCare integrates directly with Epic in both directions. Enrollment flags and orders leave the chart; discrete vitals, care documentation, enrollment status and billing-ready claims come back into it. Clinicians stay in the chart they already use, and the practice's biller does not learn a new claim path.
Enrollment flags and trigger ordering sit in the clinical workflow. CoachCare's team enrolls the flagged patients on the practice's behalf, status shows in Epic in real time, and patients begin receiving services in under five days.
Device readings file as discrete vitals in the flowsheet, not as attachments. The care summary and evidence of care post to the chart monthly, which is what makes a time-based claim hold up under audit.
CoachCare is the only care-management application integrated with Epic that generates the claim automatically, for every enrolled patient, every month. The manual claim step a new billing operation would otherwise inherit never exists.
Integration setup for Epic runs $4,000 one time, with a $150 monthly interface fee and $1.50 per enrolled patient per month. Those figures are carried in the financial summary below and confirmed in contracting. One item for the first conversation: which Epic instance hosts the practice, and who owns the interface.
The Value Analysis shows the program pays. This is the part that says it is safe, and that seven physicians see signal rather than a thousand readings a day. The routing is written into a charter the practice signs before the first device ships.
Chest pain, new shortness of breath, stroke signs, syncope, sudden swelling. CoachCare's urgent and emergent policy supersedes any practice-specific preference. If the patient refuses, the clinic is notified; otherwise CoachCare activates 911.
Out-of-range but not emergent findings route to the clinician or nurse the practice names in the charter, with the readings, the symptom check and the recommended next step attached.
A retake that lands in range and a clean symptom check closes the loop with a chart note and nothing else. The cardiologist's inbox is reserved for what needs a decision.
An unreachable patient is re-attempted on a schedule, the practice is notified at every decision point, and a patient who stops transmitting is worked before a billing month is lost. Discharge from the program follows the same written criteria, with the clinic told every time.
Any emergency visit or hospitalization in the preceding 60 days triggers three touches inside two weeks, and when the patient was admitted it is also the TCM episode. That cadence, on this panel, is where the 161 avoided hospitalizations over 24 months come from.
Reach the patient, reconcile medications against the discharge instructions, confirm the cuff and scale are transmitting.
Weight trend and symptom review, diuretic plan confirmed, follow-up appointment confirmed with the practice.
Close the episode or extend it; anything trending is escalated through the engine above.
A 24-month forecast for the RPM + PCM stack: 6,400 Medicare patients in scope for Year 1 out of a Medicare panel of about 8,000, 10 referring clinicians (seven physicians and three nurse practitioners), one CoachCare-funded on-site enrollment specialist, Arizona statewide locality rates and the Epic integration. Transitional care is not in these numbers, and neither is the commercial or AHCCCS panel.
| Program | Net reimbursement | CoachCare fees | Net to practice |
|---|---|---|---|
| RPM: devices, data and management | $2,307,047 | $1,290,426 | $1,016,621 |
| Year 1 / Year 2 | $593,256 $1,713,791 | $325,346 $965,080 | $267,910 $748,711 |
| PCM: principal care management | $895,573 | $467,419 | $428,154 |
| Year 1 / Year 2 | $216,618 $678,955 | $113,058 $354,361 | $103,560 $324,594 |
| Implementation, Epic integration and outreach | — | $80,585 | −$80,585 |
| 24-month total | $3,202,620 | $1,838,430 | $1,364,189 |
| Enrollment outreach, care management and device logistics are CoachCare's expense: embedded in the fee, never a separate charge to the practice and never deducted from its margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 41.67%, Year 2 42.91%).
Year 1 is $337,461 net to the practice on $809,874 of net reimbursement; Year 2 is $1,026,728 on $2,392,746. Month 1 is −$4,648 as the one-time setup lands ahead of the ramp; monthly net is positive from month 2 onward.
Recurring professional-fee volume over 24 months, generated inside Epic by the billing engine.
Blood pressure, heart rate and weight, a continuous picture of the panel between visits, triaged before a physician sees any of it.
About $2.42M in acute-care cost that never gets spent, at $15,000 per admission. Outside the forecast, and the start of the practice's own outcome record.
About 27,778 care-team hours of monitoring, outreach and documentation carried by the service line, not by a practice that is still hiring its front desk.
The two programs are constrained by different things. Remote monitoring reaches its eligible pool of 1,680 in month 20; after that its census holds and its economics flatten. Principal care management never gets there: at month 24 it stands at 813 of a 1,632 ceiling, about 50% full, still adding patients every month. The ceiling is not the constraint on care management; enrollment capacity is. That is what the second table measures.
| Program | Enrollment ceiling | How it is defined | Month 24 |
|---|---|---|---|
| RPM | 1,680 | 6,400 in scope × 75% eligible × 35% acceptance · reached in month 20 | 1,680 |
| PCM | 1,632 | 6,400 in scope × 85% eligible × 30% acceptance · still climbing | 813 |
| At month 24 | — | Active program enrollments = 1,924 unique patients | 2,493 |
Eligibility is set for a cardiology Medicare cohort. Every point of eligibility or acceptance the practice's own chart supports beyond these raises the remote-monitoring ceiling directly; for care management it raises a ceiling that is not yet binding. Year 1 lands at 1,153 unique patients.
| Enrollment staffing | 24-mo net reimbursement | Net to practice | Unique, M24 |
|---|---|---|---|
| Practice referrals only, no on-site specialist | $1,540,809 | $646,842 | 1,110 |
| One CoachCare-funded on-site specialist (this forecast) | $3,202,620 | $1,364,189 | 1,924 |
| Two specialists | $4,243,966 | $1,823,027 | 2,077 |
| Three specialists | $5,001,346 | $2,163,975 | 2,170 |
A second CoachCare-funded specialist adds $1,041,346 of net reimbursement (+32.5%) and $458,838 net to the practice over 24 months, because care management has room to fill and remote monitoring reaches its ceiling months sooner. A third adds $1,798,726 and $799,785. Without a funded specialist the practice's own referral flow reaches less than half the forecast.
CoachCare operates as the service line's engine while the practice's cardiologists govern protocols and every clinical decision. Launch needs no new hires and no capital, the Epic integration is direct, and the transitional-care path produces cash before any device ships. For a group that is building its billing operation right now, the remote care claim path goes in alongside the office-visit claim path instead of after it.
Agree the escalation routing and who receives non-critical alerts. Pull the heart-failure, atrial-fibrillation and uncontrolled-hypertension cohorts out of Epic and confirm the enrollable list against the panel in this analysis.
Turn on the Epic integration, configure the time-capture and code mapping under the practice's own billing number, and run a claims test on the transitional care management path first.
The funded specialist starts at the North 12th Street office, working from the confirmed cohort list. Devices ship to enrolled patients. First readings arrive and the escalation engine goes live with the practice watching every route.
The census builds toward the curves in the analysis. Blood-pressure control, titration documentation and post-discharge touches accumulate as retrievable reports, the outcome record a new practice needs for every payer conversation it is about to have.
The service line on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs day to day on the CoachCare platform.
Programs stood up and running in market.
Care-plan coding and billing behind more than 5 million claims. The billing path is the part most remote-care programs get wrong, and the part a new practice can least afford to.
Over 100 million vitals recorded and 4 million+ care actions enabled.
CMS has proposed cutting the remote-monitoring device-supply codes for CY2027. The proposal is narrower than the headline. Here is what it does to the forecast on this page, priced at the Arizona statewide locality amounts the forecast itself uses rather than national averages.
The proposal reaches the remote-monitoring family only. Principal care management is not in it, and on this forecast PCM carries $895,573 of the $3,202,620 in 24-month net reimbursement. Its own amounts move by well under a point through the conversion factor, so $4,508 of the $223,662 total sits outside the remote-monitoring arm.
Two contingencies are already in build. An unbundled arrangement, with the software platform, device logistics and program enablement priced separately, and an arrangement in which CoachCare manages the staffing while the practice owns the clinical program and the billing. Whichever way the final rule lands, the program does not have to be rebuilt.
CMS's ACCESS Model points at the destination: remote care paid as a risk-based per-member-per-month amount, with half of each payment withheld and reconciled against outcome attainment. A practice that builds the documentation and outcome-reporting habit into its first year of operation is the practice that can take that payment when it arrives.
Three numbers, each smaller than the last, because each one sits on a larger base. Both bars are drawn on one shared dollar scale, so the copper can be compared directly across them.
24-month net reimbursement, CY2026 final versus CY2027 proposed, every code repriced at Noridian Arizona statewide locality (03102-00) amounts, non-facility, on this forecast's own billing mix. Enrollment, acceptance and mix held constant. This is the rate change alone.
National non-facility amounts from the proposed rule's Addendum B, so the movement can be read without a locality in the way. The repricing above uses Arizona statewide locality amounts; the two bases do not reconcile to the dollar, by design.
| In scope: remote monitoring | ||||
|---|---|---|---|---|
| Code | What it pays for | CY2026 | CY2027 | Change |
| 99453 | Setup and patient education | $21.71 | $20.03 | −7.7% |
| 99445 | Device supply, 2–15 days | $52.11 | $41.38 | −20.6% |
| 99454 | Device supply, 16–30 days | $52.11 | $41.38 | −20.6% |
| 99457 | Treatment management, first 20 minutes | $51.77 | $49.59 | −4.2% |
| 99458 | Treatment management, each additional 20 minutes | $41.42 | $40.39 | −2.5% |
| 99470 | Treatment management, first 10 minutes | $26.05 | $20.69 | −20.6% |
| Not in scope: principal care management | ||||
| 99426 | Principal care management, first 30 minutes (clinical staff) | $67.80 | $67.00 | −1.2% |
| 99427 | Principal care management, each additional 30 minutes | $54.11 | $54.52 | +0.8% |
| 99424 | Principal care management, first 30 minutes (physician) | $87.51 | $84.40 | −3.6% |
| 99425 | Principal care management, each additional 30 minutes (physician) | $61.46 | $59.11 | −3.8% |
The device-supply and short-treatment codes are held to a one-year maximum reduction by section 1848(c)(7) of the Act, which phases any decrease of 20 percent or more over two years. CY2027 is the capped year; the remainder of the crosswalk lands no earlier than CY2028.
The comment period on CMS-1848-P closed September 14, 2026. The final rule publishes in early November 2026 and takes effect January 1, 2027. CoachCare is leading advocacy on the remote-monitoring provisions and will rerun this forecast against the final rates the week they publish.