Original Medicare vs. Medicare Advantage
Understand why a Medicare-covered service and an incremental payment opportunity are not always the same question.
Open guide
Request an assessment PAYER-SPECIFIC RESOURCE LIBRARY
Make reimbursement decisions with the patient, plan, and operating model in view.
These concise guides help practices frame the questions to resolve before enrollment, staffing, or revenue projections. They are educational resources—not legal, coding, or billing advice.
Request a payer and population reviewBefore you project revenuePatient eligibilityPlan and contractClinical and workflow evidencePatient responsibility
START WITH THE RIGHT QUESTION
Four payer lenses every practice should use.
No page can confirm payment for an individual patient. These guides help you identify what needs to be checked with current payer policy, contracts, professional coding guidance, and your own compliance team.
Medi-Cal and Medi-Medi planning
Use a member-, plan-, county-, and contract-level review before presenting a remote-care model in California.
Open guideFQHC and RHC considerations
Account for the distinct payment and reporting environment before applying a physician-fee-schedule assumption.
Open guidePatient cost share and consent
Make the patient’s responsibility, consent, communication preferences, and enrollment choice part of program design.
Open guideTHE REVIEW SEQUENCE
Clinical need first. Payment pathway second.
- Define the care need. Which patients would clinically benefit, and what care work must be sustained?
- Identify the payer and arrangement. Original Medicare, Medicare Advantage, Medi-Cal, Medi-Medi, commercial, FQHC/RHC, delegated, or capitated models require different questions.
- Validate the operating evidence. Confirm the required consent, documentation, data, time, supervision, and handoffs can be delivered consistently.
- Communicate clearly with patients. Explain purpose, choice, expected contact, and any potential responsibility before enrollment.
Last reviewed: September 2026. Coverage, payment, code descriptors, managed-care policies, contracts, and patient responsibility change. Confirm current authoritative guidance and the patient’s actual plan before billing or quoting an amount.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
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