The CY2026 fee schedule pays monthly for physiologic remote monitoring — blood pressure, weight, pulse oximetry — and for the management time spent acting on it. No public source evidences this practice billing any of it. That unclaimed, recurring layer is what this page sizes — built on review-and-triage work of the same kind the practice's electrophysiology service already performs on rhythm data, so it is operational proof, not a cold start.
Source: the companion CoachCare Value Analysis workbook, CY2026 rates auto-resolved for MAC locality CA • 01182-17.
One market note before the numbers: Ventura County Medicare runs 58.3% traditional fee-for-service and 41.7% Medicare Advantage (CMS Medicare Monthly Enrollment, April 2026 release, CY2025 figures). Every figure on this page is a fee-for-service figure. The Advantage slice is real and rising roughly half a point a year — treat it as a second, additive conversation rather than as part of the model.
This is not a group that needs convincing that protocol-driven, between-visit care works. Its own published service pages describe a rhythm-monitoring capability, and its own Medicare panel is the textbook indication for the physiologic programme sitting beside it. What follows is what the public record supports — stated at its true strength and at its true limits.
Insertable cardiac monitors, mobile cardiac telemetry explicitly characterised as transmitting arrhythmias wirelessly to clinicians, 14-day ambulatory patch monitoring, Holter and symptom-triggered event recorders, and implanted-device checks on a three-to-six-month cadence. This is a published capability.
Across the eight CY2024 rendering panels: hypertension 75%, ischemic heart disease 44–61%, heart failure 24–56%, atrial fibrillation 34–74%, chronic kidney disease 29–45%, diabetes 35–53%. The rhythm panel is the sharpest version — 56% heart failure and 74% atrial fibrillation. Essentially every patient carries two or more chronic conditions.
A California professional medical corporation holding its own Medicare group enrollment under PAC ID 5890693279, with a PECOS record dating to December 2003 and a twelve-clinician referral bench across two evidenced offices — Oxnard and Camarillo. No health system, foundation, management-services organisation or private-equity sponsor appears in any public record, and a 24-month news sweep surfaced no transaction. The service line accrues to the practice.
No physiologic remote monitoring and no monthly care management appears anywhere in the public record: no programme page, no named device or monitoring vendor, no care-coordinator or chronic-care nurse posting, and no code-set evidence. Multiple independent sources point the same way.
The hard part of a remote programme is not the technology. It is the operating habit — a triage inbox, an alert-review protocol, a documented escalation standard, and clinicians who trust data that arrives between visits. On the rhythm side, that habit is published. The physiologic side is where the fee schedule pays separately, and it appears unbuilt.
Nothing here is a deadline. The case is a billing case, a market case and a contracting case — three things that happen to line up favourably in 2026 for an independent, procedure-heavy cardiology group in a majority fee-for-service county.
New code 99445 pays the monthly device-supply amount for 2–15 days of data where 16 or more were previously required, and 99470 pays for the first 10 minutes of monthly management time where the floor had been 20.
Why that matters more here than at most cardiology groups: this practice's revenue is dominated by procedures and imaging rather than office visits, so its population is episodic by construction — a patient arrives, is imaged or treated, and leaves. The days after a cardiac discharge, an ablation, a device implant or a structural procedure were clinically the most consequential and financially invisible. A code written for two to fifteen days of data is a code written for this practice's shape.
Ventura County Medicare runs 58.3% traditional fee-for-service against 41.7% Medicare Advantage as of CY2025 — below the national Advantage average and well below California's most penetrated counties. This is not an Orange County or Los Angeles County payer structure.
More usefully, the fee-for-service pool has grown in absolute terms across the whole period — 97,537 beneficiaries in 2019 against 101,650 in 2025 — while total county Medicare grew 16.2%. Because these are fee-for-service benefits, the depth of that pool is the business case.
Two verification questions were run to conclusion against the current published CMS participant files, and both came back clean in the practice's favour: no mandatory model exposure — pure-upside timing, and prepared if selection maps change.
And on shared savings: the CMS Medicare Shared Savings Program participant files were searched in full for both PY2025 and PY2026 — 15,192 and 15,370 participant rows — and the practice appears in zero rows in either year. This page therefore makes no claim of accountable-care-organisation participation. Network membership is confirmed by the networks' own directories; participant-TIN status is verified-negative. Practically, that means no direct shared-savings risk sits on this TIN to offset the professional fee.
A named service line with its own owner, P&L and scorecard, rather than a point solution bolted onto one condition. It follows the Medicare patient from the hospital bed back into the clinic and then across the year, and the same build serves every lever the practice already cares about.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use | In the model? |
|---|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200 / ~$280 | Every cardiac and post-procedure discharge from the county's principal cardiac hospital and its sister campus | No — upside |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 unlocks the 2–15-day post-discharge and post-procedure window | Yes |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, titration, escalation | Yes |
| Principal Care Management | 99424 · 99425 · 99426 · 99427 | ~$60 + ~$50 add'l | A single high-risk cardiac condition expected to last ≥3 months | Yes |
Magnitudes shown are national non-facility approximations. The value analysis below uses CY2026 rates auto-resolved by MAC carrier and locality for zip 93030 — CA • 01182-17 — not these national figures.
And a boundary worth drawing early: the cardiac rhythm and device family (93294–93299) is a different code set, a different clinical workflow and a different revenue stream from physiologic remote monitoring. Nothing in this stack overlaps it. The documentation boundary between the two should be written down before the first enrolment so neither service is ever at risk.
The same infrastructure — enrolment, devices, alert triage, escalation, documentation, billing capture — powers each thing the practice already cares about.
The practice already has access to a real, staffed care-coordination programme through its clinically integrated network. Any proposal that appears unaware of it deserves to be answered in one sentence. So this section describes that programme accurately and respectfully first, and only then sets out what sits beside it — because on the evidence they are complementary instruments, not competing ones.
Eight questions worth asking of any option on the table — the network programme, an in-house build, a competing vendor, or the service line proposed here. The right way to compare instruments is to test them all the same way, including this one. Where an answer is not publicly established, it is written as a question rather than guessed at.
| The question | The network care-coordination programme | Building it in-house | A CoachCare-operated service line |
|---|---|---|---|
| Is the enrolment labour physically present? | Coordination is delivered by the network's own staff, working alongside the practice. Whether any of that capacity is spent on enrolling this practice's panel into billable programmes is not described — ask | One nurse practitioner and two physician assistants across nine physicians. Enrolment would compete with clinical throughput | Yes — one on-site enrolment specialist, plus telephonic outreach. Staffed at CoachCare's expense, never a deduction from practice margin |
| Is the full code set captured, including the add-on rungs? | Neither published page describes the monthly care-management codes. The network's transitional-care material tells the practice to bill that service itself | Possible, but add-on capture (99458, 99425–99427) is where in-house programmes most often leak revenue | Yes — RPM and PCM including add-on rungs, with capture assumptions itemised in the companion workbook |
| Who owns the clinical governance? | Physician-directed at the network level, with shared care plans returned to the practice | The practice, entirely — which is the appeal, and the workload | The practice — thresholds, routing matrix and discharge criteria are the practice's to set; see Clinical Governance below |
| Is the documentation audit-proof? | Not established publicly — ask | Depends entirely on the template discipline of whoever builds it | Yes — every escalation carries the same six documented fields, so any event can be reconstructed end to end |
| Is claim generation automated? | Not applicable — the practice does not bill for the programme | Manual claim assembly, every patient, every month | Yes — automated claim creation through the billing engine, inside the eClinicalWorks environment |
| Does the referring physician get a report? | Outreach reports and shared care plans flow to the member practice | Achievable, rarely sustained without a system behind it | Yes — structured monthly reporting from the practice back to the referring physician, which is where referral durability sits |
| Is the panel segmented by payer? | Scoped to the network's attributed population | Requires a payer-mix analysis the practice would have to run itself | Required, and not yet done — the traditional-Medicare / Advantage split is the number-one discovery item and no public source supplies it |
| Who is the billing entity, and where does the fee land? | The practice bills nothing; the coordinator's time is the network's cost and the economics are shared-savings | The practice — with the full build cost as well | The practice, under its own TIN, with CoachCare compensated by a fair-market services fee rather than a share of collections |
In many accounts the electronic health record is the hardest scoping question. Here it is one of the easier ones: the platform is confirmed from direct evidence, it is a cloud-hosted tenant rather than a self-hosted deployment, and it is the ambulatory system CoachCare has the deepest native integration with.
The specific eClinicalWorks version and edition, and whether the practice holds the vendor's patient-engagement application licence, are unverified. Both affect enrolment workflow design.
Whether interface work is handled internally, by the vendor, or by a contracted partner — and whether any interface budget exists — is not established and is a straightforward discovery question.
Anything already connected to the tenant shapes sequencing. So does the rhythm-monitoring platform question: whichever system the device transmissions are reviewed on today is a system this programme sits beside, not inside.
No interface cost, timeline or capability is priced into the forecast on this page, and none is claimed. Scoping happens after the platform details are confirmed directly.
The economics prove the service line pays. This proves it is safe and disciplined. Every reading a patient takes routes through one shared escalation engine with defined thresholds, defined trends, defined routing and a defined documentation standard — so the care team receives signal, not noise, and never carries surveillance liability it did not agree to.
Both programmes in this service line — remote physiologic monitoring and principal care management — route through the same logic. The engine is programme-agnostic; the thresholds are set with the practice.
A reading at a critical threshold escalates regardless of whether the patient reports symptoms. There is no "wait and see" branch on a critical value, and no client preference can suppress it.
A non-critical out-of-range reading is worked rather than forwarded: confirm technique, retake, then run a structured symptom check. Most out-of-range readings resolve here — which is exactly why the clinic inbox stays clean.
An out-of-range trend is not a judgement call. It is three consecutive readings at least one hour apart for blood pressure or glucose, or three readings within seven days for heart rate. A confirmed trend escalates on the same footing as a threshold breach.
If the patient cannot be reached, the attempt is documented, a voicemail and callback request are left — and if the reading was critical or a confirmed trend, the escalation proceeds anyway. Silence never downgrades a clinical finding.
Six fields, every time, so the record is auditable and any event can be reconstructed end to end.
Triggered automatically by any emergency-room visit or hospitalisation reported in the last 60 days. This is the readmission-prevention spine — the mechanism behind the 179 hospitalizations avoided in the forecast below.
Confirm the patient is home and safe, reconcile discharge medications against what is actually in the house, verify follow-up appointments exist, and confirm the monitoring device is set up and transmitting. Clinical alerts documented and escalated per the engine above.
The window where post-discharge decompensation typically declares itself. Symptom review, weight and blood-pressure trend review against the readings already flowing in, adherence check, and escalation on any confirmed threshold or trend.
Confirm the follow-up visit happened, close open issues, verify the patient understands the escalation path, and hand the patient into the longitudinal monitoring panel so the 30-day window closes with continuity rather than a cliff.
Patients do not silently fall out of the programme, and the care team is notified at every decision point.
A patient who stops responding is escalated to the practice first, then re-escalated every 30 days — not quietly dropped and not left accruing.
If no instruction is received from the practice, discharge proceeds at 180 days. The clinic is notified in every case, and discharges generally process in the first week of the following month.
Clinical discharge criteria, escalation thresholds and routing are the practice's to set. CoachCare executes them consistently and documents the execution — it does not overrule clinical judgement, with the single exception of the emergent floor above.
Because every escalation carries the same six documented fields, any episode of care can be reconstructed end to end — which is what a California professional medical corporation retaining clinical control actually requires of a services partner.
A 24-month forecast for a two-programme service line — remote physiologic monitoring and principal care management — across two offices, a twelve-clinician referral bench, one CoachCare-funded on-site enrolment specialist, and CY2026 rates auto-resolved for MAC locality CA • 01182-17. Transitional care management revenue, avoided-admission savings, referral durability and procedural throughput are not in these numbers. Neither is any Medicare Advantage, commercial or Medi-Cal volume. They are upside on top.
| Line | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $752,743 | $2,210,393 | $2,963,136 |
| PCM net reimbursement | $258,716 | $810,791 | $1,069,507 |
| Total net reimbursement | $1,011,459 | $3,021,184 | $4,032,643 |
| CoachCare fees | $585,839 | $1,725,963 | $2,311,802 |
| Practice net (after fees) | $425,620 | $1,295,221 | $1,720,841 |
| Practice margin | 42.08% | 42.87% | 42.67% |
| Includes one on-site enrolment specialist staffed at CoachCare's expense — embedded value already reflected in the fees above, never a deduction from practice margin. | |||
Month-1 practice profit is −$4,037; the first profitable month is month 2. Fee-for-service only, and priced on a services-agreement structure rather than any share of collections. The full model is available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months — on top of the existing procedural and imaging book, not instead of it. At this volume the claim has to be generated by the billing engine, not assembled by hand.
A continuous clinical picture of the heart-failure, hypertension and rhythm panels between visits — the physiologic twin of the rhythm data these clinicians already review.
Roughly $2.7M of avoided acute cost at an assumed $15K per admission. That value accrues to the payer and the admitting hospital, not to the practice's P&L — and it is not double-counted in the table above.
30,479 care-team hours of monitoring, outreach, escalation and documentation carried by the service line rather than by the practice's own staff — which matters where the advanced-practice bench is three clinicians deep.
Every figure in this section is priced at fee-for-service rates for MAC locality CA • 01182-17; Medicare Advantage, commercial and Medi-Cal volume is not modeled and is a separate conversation.
Every input below is an assumption, and every assumption is arguable. Move them and the 24-month forecast recomputes live. At the modeled settings this engine reproduces the companion Value Analysis workbook exactly — so any disagreement you have with the output is really a disagreement with an input, which is a much more productive conversation.
"Enrolled services" counts active programme enrolments; a patient enrolled in both programmes counts twice. At month 24 the model's 2,790 enrolled services correspond to 2,180 unique patients once dual enrolment is deduplicated. All outputs are fee-for-service.
CoachCare operates the engine — enrolment outreach, device logistics, 24/7 monitoring, escalation and billing-ready documentation — while the practice's physicians govern the protocols and make every clinical decision. Full-service delivery means launch requires no new headcount on the practice's side, and the on-site enrolment specialist in the model is funded by CoachCare.
Answer the four questions no public source can: the traditional-Medicare versus Advantage split; what is billed today for remote monitoring and on whose platform; whether the practice uses the network's coordinators and on what terms; and the practice's own unique-patient count. In parallel, draft the commercial structure as a fair-market services and technology agreement, confirm the billing configuration for MAC locality CA • 01182-17, and agree the escalation matrix, the discharge criteria and the bilingual staffing plan.
Start where the panel is sharpest — the electrophysiology population running 56% heart failure and 74% atrial fibrillation, already accustomed to this practice reviewing their data between visits. Write the documentation boundary between the rhythm and device family and physiologic monitoring before the first enrolment, so neither service is ever at risk. Stand up integrated ordering, enrolment flags and automated claim generation inside eClinicalWorks.
Oxnard and Camarillo enrolling on the same protocols, with the post-procedure windows added as the second wave — post-ablation, post-device, post-structural, post-peripheral. Monthly scorecard reporting to service-line governance: census, capture rate, revenue per patient-month, escalation volume, Spanish-language contact rate, and referring-physician report delivery.
A documented post-discharge performance record to take to the hospital partners, a named heart-failure pathway where none previously existed, an attribution policy agreed with the network so no patient is touched twice, and a standing programme rather than a proposal when the CY2027 fee schedule lands and Advantage contracting comes up for renewal.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 conditions managed for more than 500,000 patients.
Providers running remote care programmes on CoachCare today.
Remote care programmes implemented for provider organisations.
Care-plan coding and billing that has produced over five million claims.
Over 100 million vitals recorded and more than four million care actions.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how the operating model behind this service line absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That distinction lands directly on this forecast — PCM carries $1,069,507 of the modeled $4,032,643 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the service line's economics hold wherever the rule settles. One unbundles the program into its parts — SaaS platform, device logistics, and program enablement — priced as components. Another engages CoachCare to run the staffing itself, an MSO-style arrangement in which the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is among its four clinical tracks. What earns under that structure — controlled pressures, titrated therapy, decompensations caught early — is what this service line is built to produce.
This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality rather than national averages. Same enrollment, same phasing plan — only the rates move.
Both bars run on the same dollar scale, so the red slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the care-management revenue RPM alone does not include.
Repriced at this locality's own geographic adjusters. The RPM reductions fall almost entirely on practice expense, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be −8.8% on RPM. Of the $279,342, RPM accounts for $278,482 and the care-management arm for $859.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99424–99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those families moves within about 4% in either direction, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, and CMS publishes the affected codes, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.