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
Cardiology, nephrology, and other medical specialties
Build focused support around a serious condition and the clinical information the specialist needs between visits.
RELEVANT PATHWAYS
Programs to consider for your patients
PCM · Principal Care Management
One qualifying serious chronic condition with a complex disease-specific plan.
Patient example, requirements, and billingRPM · Remote Physiologic Monitoring
Relevant home readings and a clear treatment-response workflow.
Patient example, requirements, and billingCCM · Chronic Care Management
Multiple qualifying conditions when the practice actually provides broader care management.
Patient example, requirements, and billingRTM · Remote Therapeutic Monitoring
A separately appropriate therapeutic pathway, such as eligible respiratory-treatment monitoring.
Patient example, requirements, and billingHow to choose—and what must be verified
Consider PCM for one qualifying complex, high-risk condition; RPM when physiologic readings can guide treatment; and CCM when your practice actually owns whole-person management of multiple qualifying conditions. Coordinate with primary care before assigning ownership.
Do not use concurrent primary-care CCM and specialist PCM as a default revenue example. Confirm the actual independent services, coordination, payer, and claim edits first. RPM and RTM cannot be billed together for the same Medicare patient.
PAYMENT & FINANCIAL PICTURE
How would payment and practice costs work?
The eligible practitioner receives payment for supported services under the relevant contract. A specialty label or single diagnosis does not by itself earn PCM. Any monitoring service needs its own evidence and overlap review.
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.
- Distinguish device-related collections from management collections; buying or shipping a device does not earn the full program payment.
- Budget specialist review, coverage, devices, connectivity, support fees, and staff documentation. Review ESRD, facility, and payer-specific payment arrangements before estimating revenue.
Illustrative PCM 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
From home information to a specialist decision
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
- 1
Choose the clinical question
Specialist
For example, determine whether home blood-pressure or weight trends are needed to manage the patient’s condition. Confirm the chosen service is clinically appropriate.
- 2
Set a plan and alert route
Specialist + care team
Record individualized thresholds, medications, follow-up, urgent instructions, and who covers incoming concerns. Complete required enrollment steps.
- 3
Support data and adherence
Patient + agreed team
Teach use of the qualifying device when applicable, check transmission, and follow the approved medication and appointment plan. Record actual eligible work.
- 4
Act on meaningful changes
Specialist
Evaluate escalations and make authorized treatment decisions. Share relevant changes with primary care and other treating clinicians.
- 5
Close the service period
Practice billing and clinical leads
Verify data, communication, time and other service requirements as applicable; exclude duplicated work and review collections and clinical goals.
Your first step
Choose a condition and a measurable care goal. Name the clinician who will act on data, confirm payer and dialysis or other bundled-payment restrictions, and agree on records access with the patient’s other clinicians.
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.
Cardiology
A heart-failure patient may need coordinated treatment changes and clinician-selected home measurements.
Nephrology
A high-risk kidney-care patient may need medication, test, and referral coordination through a focused plan.
Pulmonology or endocrinology
Choose condition-specific follow-up and appropriate monitoring rather than assigning the same device to every patient.
ONE ILLUSTRATIVE PCM JOURNEY
See the patient, practitioner, and support roles.
Meet Aisha: her kidney disease needs frequent treatment adjustments and coordination with other clinicians.
Qualify the condition
Before enrollment- Patient / caregiver
- Discusses the focused program, consent, and possible costs.
- Treating practice
- Confirms a qualifying high-risk condition and the initiating visit.
- PrimeVital’s agreed role
- Supports intake and identifies coordination gaps.
- What gets recorded
- Condition, duration, risk, complexity, and responsible practitioner.
The sample goal
Help Aisha carry out the kidney-care plan and resolve treatment barriers.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
The specialist determines clinical need, sets individual goals and escalation instructions, makes treatment changes, and reviews the evidence and claim.
PrimeVital’s agreed support
The agreed care-management team can support enrollment, patient follow-up, coordination, and documentation. Applicable devices can be part of the full care arrangement; billing handoffs follow the specialist’s workflow.
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.
- Confirm risk, duration, management complexity, and the disease-specific plan for PCM.
- Identify who performs qualifying work and which time pathway applies.
- For monitoring, confirm suitable technology, actual data, communication, and clinical response.
- Coordinate with primary care and other specialists to avoid duplicate work.
- Verify payer terms and the practice’s professional and setting eligibility.
COMMON OWNER QUESTIONS
Resolve these before committing.
Who changes medicines?
Your authorized treating professional makes the decision. The support team follows the agreed plan, documents concerns, and escalates; a device alert does not authorize an automatic medication change.
What if primary care already provides CCM?
Identify existing services and their owners. Disease-specific specialist work needs its own clinical basis and applicable billing review; do not duplicate another team’s time or service.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Treatment and test follow-through
- Clinician-selected disease trends
- Escalations resolved and handoffs completed
- Care-team time and actual 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