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
Primary care
Connect chronic conditions, home readings, transitions, and behavioral-health needs to the patient’s primary-care plan.
RELEVANT PATHWAYS
Programs to consider for your patients
CCM · Chronic Care Management
Multiple qualifying chronic conditions and a whole-person care plan.
Patient example, requirements, and billingAPCM · Advanced Primary Care Management
A practice ready to provide the full longitudinal primary-care model.
Patient example, requirements, and billingRPM · Remote Physiologic Monitoring
Physiologic readings that can inform treatment.
Patient example, requirements, and billingTCM · Transitional Care Management
A qualifying discharge and a practice able to own the transition.
Patient example, requirements, and billingBHI · Behavioral Health Integration
Coordinated behavioral-health follow-up with the appropriate team.
Patient example, requirements, and billingPCM · Principal Care Management
One unusually complex, high-risk condition when disease-specific management fits.
Patient example, requirements, and billingHow to choose—and what must be verified
Choose CCM for eligible patients needing time-based whole-person coordination, or evaluate APCM if your practice can provide the complete primary-care model. Add RPM only when home measurements answer a clinical question. These are not automatic payments to combine.
APCM requires the full model, including practice-level urgent access and reporting. Purchasing outreach or a device alone does not establish APCM. The agreed PrimeVital staffing hours must be specified separately.
PAYMENT & FINANCIAL PICTURE
How would payment and practice costs work?
The eligible practice submits supported professional claims or follows its payer contract. PrimeVital is paid through its service agreement. CCM and APCM are choices to evaluate, not automatic payments to stack for the same work.
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.
- Model one supported program first using your payer and locality. Include nonqualifying months, patient cost sharing, denials, practitioner review time, and service fees.
- APCM has no monthly minute threshold, but requires the full practice model, including 24/7 urgent access and performance reporting. CCM, PCM, and TCM elements included in APCM are not separately stacked. Confirm the applicable code edits for any additional service.
Illustrative RPM 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
A primary-care pilot between office visits
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
- 1
Select the patient
Treating practitioner
Identify clinical need, confirm the appropriate program and payer, complete any required initiating visit, and explain patient costs and consent.
- 2
Build one shared plan
Practitioner + care team
Record medicines, patient goals, referrals, contact preferences, and who responds to urgent concerns. Decide which readings, if any, will change care.
- 3
Carry out follow-up
Agreed care-management team
Help with medication and appointment follow-through, review authorized data, and record work in the agreed system. Interactly can help with administrative scheduling and messages.
- 4
Resolve clinical concerns
Your practitioner
Review escalated symptoms, readings, or medication questions; make treatment decisions and update the plan. Agree on response times and coverage before launch.
- 5
Review service and results
Practice billing lead + clinical lead
Check required service elements, eligible time where applicable, overlapping work, and actual collections. Compare patient goals and staff workload with the starting baseline.
Your first step
Pick one patient group and one clinical lead. Review payer coverage, current care-management providers, urgent-access arrangements, consent, and your records workflow before enrollment. Agree on a limited pilot and a review date.
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.
Diabetes and heart failure
Consider CCM for medicines, referrals, and a shared plan. Useful home readings may justify a separate RPM assessment.
A primary-care home
Consider APCM when access, coordination, electronic planning, population management, and performance reporting are in place.
Returning from hospital
Assess TCM eligibility and deadlines before assuming the follow-up is a separate transition claim.
ONE ILLUSTRATIVE RPM JOURNEY
See the patient, practitioner, and support roles.
Meet Maria: her primary-care clinician wants a clearer picture of her blood pressure between appointments.
Choose patients
Before enrollment- Patient / caregiver
- Decides whether to join and understands possible costs.
- Treating practice
- Confirms medical need, an established relationship, goals, and the payer pathway.
- PrimeVital’s agreed role
- Coordinates onboarding and consent documentation within the agreed workflow.
- What gets recorded
- Clinical reason, consent, responsible practitioner, and coverage checks.
The sample goal
Understand Maria’s blood-pressure trend and help her follow the treatment plan.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
Your practitioner selects patients, directs the plan, makes treatment decisions, responds to clinical escalations, and approves final documentation and claims.
PrimeVital’s agreed support
The full care arrangement can include applicable devices and a care-management team. We help organize enrollment, follow-up, records, and billing handoffs. Interactly can support front-desk scheduling and messages.
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.
- Select patients based on clinical need and payer, not diagnosis counts alone.
- Name the clinical and billing owner; complete initiating visits and consent where required.
- Maintain plans, access arrangements, follow-up, and escalation responsibilities.
- Agree on care-team credentials, supervision, service hours, records access, and billing handoffs.
- Check other practitioners, bundled contracts, and services already paid for.
COMMON OWNER QUESTIONS
Resolve these before committing.
How much doctor time is required?
There is no single staffing estimate for every panel. Your practitioner selects patients, directs plans, and resolves clinical issues. Agree on an escalation workload and review it during the pilot; staff work and practitioner-personal codes have different requirements.
Can the care team replace our urgent-access arrangements?
Confirm the actual service hours and responsible coverage. A PrimeVital engagement does not by itself establish the practice’s program-required 24/7 access.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Patient participation and care-plan understanding
- Medication/referral gaps resolved
- Clinical trends selected by the practitioner
- Practice workload and actual net collections
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