Talk with us FOR PRACTICES & CARE ORGANIZATIONS
Find care and payment options for your setting.
Medical practices, nursing homes, skilled nursing facilities, assisted living, home health, hospice and long-term acute care organizations.
PROGRAM & INSURANCE EXPLORER
What could fit—and how would it be paid?
Explore without an NPI or contact details. Choose a practice and insurance route, then open the detailed guide.
Programs to explore for primary care
These are starting points for assessment, not eligibility decisions or a list of services to bill together.
Multiple qualifying chronic conditions and a whole-person care plan.
Read the program & requirements →APCMAdvanced Primary Care ManagementA practice ready to provide the full longitudinal primary-care model.
Read the program & requirements →RPMRemote Physiologic MonitoringPhysiologic readings that can inform treatment.
Read the program & requirements →TCMTransitional Care ManagementA qualifying discharge and a practice able to own the transition.
Read the program & requirements →BHIBehavioral Health IntegrationCoordinated behavioral-health follow-up with the appropriate team.
Read the program & requirements →PCMPrincipal Care ManagementOne unusually complex, high-risk condition when disease-specific management fits.
Read the program & requirements →Original Medicare: payment route
Published program rules and locality fee schedules provide a reference. Confirm the patient, qualified practitioner, setting and actual service before billing.
See rates or payer details →Compare programs across medical and other practices
“Explore” means this program is discussed in the practice guide. A dash means it is not highlighted, not that it is prohibited. Clinical fit and payment are separate.
CHOOSE YOUR PRACTICE
Get an answer built around your setting.
Clinical programs and operational services can help in different ways. See where your practice may fit and what it would need to do.
Primary care
Connect chronic conditions, home readings, transitions, and behavioral-health needs to the patient’s primary-care plan.
Examples, requirements, and financial pictureCardiology, nephrology, and other medical specialties
Build focused support around a serious condition and the clinical information the specialist needs between visits.
Examples, requirements, and financial picturePhysical, occupational, and speech therapy
Help patients follow an appropriate treatment plan between therapy visits and bring useful progress information back to the therapist.
Examples, requirements, and financial pictureSurgical practices and ambulatory surgical centers
Coordinate discharge instructions, patient questions, and follow-up while checking whether a separate transition claim is actually available.
Examples, requirements, and financial pictureIndependent pharmacies and pharmacy partners
Separate plan-sponsored medication review from support provided to a treating practice and from ordinary pharmacy operations.
Examples, requirements, and financial pictureChiropractic practices
Improve patient follow-through and practice operations while keeping the Medicare chiropractic benefit and remote-care eligibility clear.
Examples, requirements, and financial pictureAcupuncture and integrative pain practices
Assess your actual clinicians, covered services, and operational needs before choosing a remote-care pathway.
Examples, requirements, and financial pictureOncology and serious-illness care
Distinguish managing a serious condition from helping a patient navigate the plan and barriers around it.
Examples, requirements, and financial picturePractices integrating behavioral health
Coordinate behavioral-health needs within treating care and choose the model that matches the team you actually have.
Examples, requirements, and financial pictureHome-based and senior primary care
Connect medicines, caregivers, chronic conditions, and care transitions around the patient’s continuing primary-care team.
Examples, requirements, and financial pictureFACILITIES & RESIDENTIAL CARE
Find information for your organization.
Start with the actual care setting, existing services and responsible biller.
Nursing homes & skilled nursing facilities
Explore coordinated resident care, professional billing support and staffing without confusing facility payments with practitioner reimbursement.
Care options, payment route & implementation →Assisted living & residential senior care
Connect residents, caregivers and treating practices around care between visits.
Care options, payment route & implementation →Home health agencies
Coordinate with the treating practice while keeping agency services and professional care-management work distinct.
Care options, payment route & implementation →Hospice organizations
Explore staffing, revenue-cycle and coordination support around the hospice plan—not a default stack of additional care-program claims.
Care options, payment route & implementation →Long-term acute care hospitals & subacute settings
Strengthen discharge handoffs, billing operations and staffing, with a separate review of care after discharge.
Care options, payment route & implementation →SPECIAL PAYMENT SETTINGS
Does your organization use a different care or payment model?
FQHCs, RHCs, facility-based care, dialysis, home health, hospice, and value-based contracts need setting-specific review. Do not reuse an office-practice claim or rate without checking the applicable arrangement.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
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