Who receives the payer payment?
The eligible billing practitioner or organization receives any supported claim payment under its payer arrangement. A code price is an allowed amount, not guaranteed collections.
Talk with us FOR YOUR PRACTICE
Home-based and senior primary care
Connect medicines, caregivers, chronic conditions, and care transitions around the patient’s continuing primary-care team.
RELEVANT PATHWAYS
Programs to consider for your patients
CCM · Chronic Care Management
Multiple qualifying chronic conditions and whole-person coordination.
Patient example, requirements, and billingAPCM · Advanced Primary Care Management
The full continuing primary-care model.
Patient example, requirements, and billingRPM · Remote Physiologic Monitoring
Clinically useful connected physiologic readings.
Patient example, requirements, and billingTCM · Transitional Care Management
A qualifying facility-to-community transition.
Patient example, requirements, and billingPIN · Principal Illness Navigation
Navigation around a qualifying serious illness.
Patient example, requirements, and billingHow to choose—and what must be verified
Identify who provides and bills the medical care: a home-visiting primary-care practice, another eligible clinician, a home-health agency, or a residential facility. The patient’s location alone does not determine the program.
CCM and APCM are not an automatic stack. Define required urgent access through the practice; do not infer continuous PrimeVital clinical coverage from a program requirement.
PAYMENT & FINANCIAL PICTURE
How would payment and practice costs work?
The eligible practitioner bills supported services under the actual payer and setting rules. Home-health, hospice, facility, or other bundled arrangements cannot simply reuse office-practice assumptions. PrimeVital is paid through its service agreement.
What does PrimeVital charge?
PrimeVital’s operational fee is set in a written agreement. The practice also plans for clinician review, any device expense, patient cost sharing and unsuccessful claims.
The treating practitioner may bill a qualifying Part B service—not automatically the facility or agency.
Check enrollment, the exact service, stay dates, place of service and existing services. A Part A stay and care after discharge are different situations.
- Use the actual clinical provider and payment setting. Home health, hospice, facility bundles, and value-based contracts can change the payment route.
- Budget caregiver onboarding, clinician coverage, records coordination, technology, and support fees. A residence or nonmedical home-care company does not automatically receive professional care-management payments.
Illustrative CCM model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. PrimeVital pilot terms are not modelled automatically. Replace them with your verified contract, service mix, and cost assumptions.
Estimate net after your agreed service fee and other costs
Enter the total fees from your written agreement. No fee is prefilled. Pilot service fees are paid from collections; treatment of denied or insufficient collections must be agreed before launch.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Illustrative collections before service and practice costs: $3,500. This uses the hypothetical per-patient amount and collection rate above; it is not a code-specific Medicare estimate.
To estimate the amount remaining for the practice, open the cost section and enter the total service fee from a written proposal. We do not invent a PrimeVital price or show a misleading net amount before that is known.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
THE WORKING PROCESS
One plan across the home, caregiver, and practice
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
- 1
Confirm ownership and eligibility
Treating practice + other providers
Identify existing services, clinical needs, billing setting, and possible overlap. Complete appropriate enrollment and patient consent.
- 2
Create an accessible plan
Practitioner + patient or authorized caregiver
Reconcile medicines, record goals and follow-up, and agree on who can receive information and report concerns.
- 3
Support care at home
Agreed team + authorized caregiver
Help with appointments, medication follow-through, and applicable device use. Share records securely with the responsible practice.
- 4
Respond to concerns
Responsible treating professional
Review escalations and coordinate with other clinicians or agencies. Define urgent access and actual staffing coverage before launch.
- 5
Review service and continuity
Practice clinical + billing leads
Verify the complete chosen service, setting-specific payment rules, and nonduplicated work. Review caregiver understanding, care gaps, and collections.
Your first step
Name the clinical owner, confirm the patient’s payer and active home-health, hospice, facility, or other care arrangement, and review caregiver permissions and records access. Select one patient group and a safe escalation process.
EXAMPLES FOR YOUR SETTING
Start with a real need in your practice.
These scenarios show what to evaluate, rather than automatically assign a program or approve reimbursement.
Limited mobility and several conditions
A shared plan and named team contact can help align medicines, appointments, and caregiver tasks.
Home readings
Consider a suitable device only if the clinician will use the readings in care.
After a hospital stay
Check the transition pathway, deadlines, other providers, and existing home-health or hospice arrangements.
ONE ILLUSTRATIVE CCM JOURNEY
See the patient, practitioner, and support roles.
Meet James: he has diabetes and heart failure, sees several clinicians, and is unsure which medication list is current.
Confirm the need
Before enrollment- Patient / caregiver
- Discusses goals, consent, costs, and the right to stop.
- Treating practice
- Confirms qualifying conditions and risk; completes an initiating visit when required.
- PrimeVital’s agreed role
- Helps identify candidates and prepare the enrollment workflow.
- What gets recorded
- Eligibility, initiating-visit status, consent, and one accountable biller.
The sample goal
Keep one shared plan and resolve medication and appointment gaps.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
The primary-care clinician owns treatment and escalation decisions, required access arrangements, and final claims. Caregiver participation follows the patient’s preferences and appropriate permissions.
PrimeVital’s agreed support
The full care arrangement can include applicable devices and a care-management team for onboarding, outreach, coordination, and documentation. Interactly can support front-desk tasks within agreed hours and scope.
Service hours, professional qualifications, technology, integrations, records access, and fees are confirmed in the engagement. Front-desk automation handles agreed administrative tasks; clinical judgment and claims remain with the responsible qualified professionals.
WHAT YOU NEED TO DO
A practical launch checklist.
- Identify the treating and billing practitioner and the actual care setting.
- Agree on caregiver participation, language, contact channel, and service hours.
- Confirm consent, patient cost protections, and appropriate plans.
- Set clinical escalation, access, and record-sharing arrangements.
- Check facility, home-health, hospice, FQHC/RHC, or other payment rules where relevant.
COMMON OWNER QUESTIONS
Resolve these before committing.
Can a residential facility enroll everyone?
Enrollment needs the appropriate treating professional, individual clinical and payer assessment, consent, and complete service. Facility residence is not automatic program eligibility.
Can caregivers participate?
Yes, where appropriate and authorized. Record permissions, communication needs, and the role of the caregiver while maintaining the patient’s care plan and privacy requirements.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Caregiver and patient understanding
- Medication discrepancies and referrals resolved
- Transition follow-through
- Patient participation and practice workload
Sources and scope
Reviewed October 7, 2026. Practice type alone does not establish clinical eligibility or payment. Detailed program pages maintain the code references; use the patient’s actual payer, professional, setting, and date of service.
YOUR PRACTICE, YOUR PATIENTS
Bring us the workflow you want to improve.
Share your practice type, patient group, payer mix, and current team. We can map the care pathway, available support, launch gaps, and assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com