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
Pulmonology
Support appropriate respiratory patients with treatment follow-through, relevant home data, and a clear path for clinical escalation.
RELEVANT PATHWAYS
Programs to consider for your patients
RTM · Remote Therapeutic Monitoring
Qualifying respiratory therapy-adherence, response, or status data when the treating professional can use it.
Patient example, requirements, and billingRPM · Remote Physiologic Monitoring
Connected physiologic readings, such as pulse oximetry or weight, when clinically necessary and acted on.
Patient example, requirements, and billingPCM · Principal Care Management
One qualifying high-risk respiratory condition requiring complex, disease-specific management.
Patient example, requirements, and billingCCM · Chronic Care Management
Two or more qualifying conditions when the practice actually provides broader care management.
Patient example, requirements, and billingTCM · Transitional Care Management
A qualifying post-discharge transition with required contact and follow-up.
Patient example, requirements, and billingHow to choose—and what must be verified
First decide whether the clinical need concerns physiologic measurements, therapeutic response, or broader care coordination. That determines whether RPM, RTM, PCM, CCM, or TCM deserves a closer look.
Do not present RTM as a general COPD reimbursement guarantee or treat a consumer app as qualifying technology. RPM and RTM are alternative monitoring families for the same Medicare patient.
PAYMENT & FINANCIAL PICTURE
How would payment and practice costs work?
The eligible professional or practice receives any supported payer payment. RPM, RTM, PCM, CCM, and TCM have distinct service definitions; their code prices do not establish coverage or collections.
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.
- RPM and RTM have different service definitions; do not model both for the same Medicare patient.
- Separate setup, device or software supply, and management services. Estimate only the work and codes actually supported by evidence and the payer contract.
Illustrative RTM 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 respiratory program with a clear response owner
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
- 1
Define the monitoring question
Pulmonology clinician
Choose the condition, needed data, clinical thresholds, and whether RPM, RTM, or care management is appropriate.
- 2
Confirm technology and benefit
Practice + support team
Verify the device or software, payer policy, member benefit, professional eligibility, and patient cost.
- 3
Onboard with one plan
Agreed care team
Educate the patient, record consent and contact preferences, and coordinate with primary care and home health.
- 4
Review and respond
Qualified team + treating clinician
Track applicable data and work; send clinically meaningful concerns to the responsible professional for treatment decisions.
- 5
Audit the service
Clinical and billing leads
Check data-days, communication, distinct time, code and payer rules, and actual collections before expansion.
Your first step
Choose one respiratory cohort, define the signal the clinician will act on, confirm technology and payer requirements, and agree on a response protocol before enrollment.
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.
Respiratory treatment plan
Evaluate RTM when a qualifying therapeutic domain and technology capture information the treating clinician will review and use.
Home oxygen or symptom concerns
Assess the right medical service first. A pulse oximeter, oxygen supply, or symptom questionnaire alone does not create an RPM claim.
High-risk COPD after admission
A focused plan, post-discharge transition, or connected readings may each be worth assessing, but each needs its own criteria and nonduplicated work.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
Your pulmonology clinician selects patients and the monitoring domain, directs treatment, responds to escalations, and owns final claim decisions.
PrimeVital’s agreed support
We can scope device or software onboarding, patient outreach, work queues, records handoffs, and an agreed care-management team around the practice’s respiratory protocol.
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.
- Specify the respiratory condition, clinical question, data type, response thresholds, and treating professional.
- Confirm whether RPM or RTM technology meets the applicable code and payer requirements; do not bill both for the same Medicare patient.
- Document patient education, data-days where required, interactive communication, and management work separately.
- Coordinate with primary care, home health, and other treating teams before outreach or billing.
- Check Original Medicare, Medicare Advantage, Medicaid, or commercial terms for this patient and contract.
COMMON OWNER QUESTIONS
Resolve these before committing.
Does any oxygen reading qualify for RPM?
No. Medical necessity, a qualifying connected device, actual transmission, clinician use, and the applicable service requirements all matter.
Can our team use RTM for every COPD patient?
No. RTM needs an appropriate therapeutic domain, technology, treating professional, service work, and payer route for the individual patient.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Treatment participation
- Clinically useful signals and resolved alerts
- Unnecessary outreach avoided
- Practitioner workload and actual collections
Sources and scope
Reviewed November 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