Understand the practice before recommending the program.

Legal entity, DBA, website, primary contact, decision maker, and clinical sponsor

Practice type: independent office, multispecialty group, FQHC, RHC, hospital-owned/provider-based clinic, home-based practice, SNF/LTC, rehabilitation/PT/OT, behavioral health, pharmacy, or other

Specialties, clinician types, number of rendering clinicians, locations, counties, ZIP codes, NPIs, and TINs

Common place-of-service codes and whether any location is paid under FQHC PPS, RHC AIR, hospital outpatient, capitation, or another non-standard methodologyA county alone does not determine the payment method.

ACO, IPA, medical group, MSO, health-system, or delegated-risk affiliations

Number of active patients and the time period used to define “active”

Age bands, service area, languages, caregiver availability, transportation, digital access, and preferred communication channels

Most common diagnoses and high-need cohorts; include recent discharges, avoidable utilization, behavioral health, social needs, and chronic pain when relevant

Approximate number who may meet each clinical program’s eligibility requirements

Known exclusions or barriers: another billing practitioner, hospice, home health overlap, device/connectivity limits, inability to consent, or poor reachability

Patient count or percentage by Original Medicare fee-for-service, Medicare Advantage, Medi-Cal fee-for-service, Medi-Cal managed care, dual eligible/Medi-Medi, commercial, workers’ compensation, self-pay, and other

For every major payer: legal payer name, exact plan/product name, line of business, HMO/PPO/EPO type, network status, and approximate covered lives

For Original Medicare: participating status, Part B billing arrangement, service ZIP/locality, practitioner type, and whether the practice accepts assignment

For Medicare Advantage and commercial plans: contracted fee schedule, amendments, medical policy, authorization/referral rules, billing modifiers, place-of-service rules, and provider enrollment status

Whether payment is fee-for-service, capitated, delegated, bundled, PMPM, shared-savings, quality-incentive, or a combination

Dual/QMB population and the current process used to prevent prohibited balance billingThe patient share shown in a fee schedule is not always collectible.

Care-management, remote-monitoring, telehealth, device, or value-based payments already included elsewhere in the contract

Programs currently offered or billed: RPM, RTM, CCM, complex CCM, PCM, APCM, TCM, BHI/CoCM, PIN, CHI, CPM, annual wellness visits, home health, hospice, or related services

Codes billed, monthly claim volume, allowed amount, paid amount, denial rate, adjustment reasons, and payer differences

Who is the billing practitioner for each program and how the practice checks whether another practitioner is already billing an incompatible service

Current vendor, contract term, device arrangement, enrollment count, activation rate, and exit terms

How consent, initiating visits, care plans, device/data-day requirements, interactive time, staff time, and practitioner review are documented

How eligible patients are identified, clinically approved, contacted, educated, consented, and enrolled

Who creates and maintains the care plan; who reviews readings, messages, symptoms, and adherence

Provider-approved escalation thresholds, response times, after-hours coverage, emergency instructions, documentation, and closed-loop follow-up

How discharges, specialist updates, medication changes, missed readings, and patient opt-outs reach the responsible team

Patient cost-share explanation, language access, accessibility, complaint handling, and preferred call/text cadence

Available roles, credentials, licenses, FTE capacity, supervision model, and state(s) where patients are located

Who owns outreach, clinical review, care coordination, coding, claims, denials, quality checks, and management reporting

Hours of coverage, holidays, back-up coverage, turnover, training, and expected patient-to-staff ratios

Work that must remain with the practitioner versus work that may be performed by clinical staff or other personnel under the applicable rule

EHR, practice-management system, billing platform, clearinghouse, patient portal, phone/text platform, device platform, and analytics tools

Available interfaces: API, FHIR, HL7, secure file exchange, SSO, or manual workflow

Where eligibility, consent, readings, time, interactions, care plans, escalations, and billing evidence will be stored

Security review owner, BAA requirements, access controls, audit logs, retention policy, incident-response process, and approved communication channels

Billing owner, coding review, charge-entry timing, claim edits, clearinghouse rejections, denial workflow, and appeal ownership

Baseline clean-claim rate, denial rate and top reasons, days in A/R, net collection rate, underpayment process, and patient-balance workflow

How eligibility, payer/product, authorization, rendering NPI, place of service, modifiers, date ranges, and code conflicts are validated before billing

Whether the practice can produce an auditable packet connecting the claim to consent, eligibility, required service elements, time/data thresholds, and practitioner oversight

Primary goal: access, continuity, outcomes, utilization, workload, patient experience, revenue integrity, or a defined combination

Current baseline, target measure, measurement owner, reporting cadence, and acceptable pilot threshold

Expected eligible population, realistic enrollment rate, staffing and technology cost, device cost, training burden, and contract constraints

Executive sponsor, clinical owner, operations owner, IT/security owner, billing/coding owner, compliance/counsel contact, and final decision maker

Desired launch timing, pilot size, dependencies, go/no-go date, and reasons the practice would stop or expand