Maryland entered Performance Year 1 of the AHEAD Model on 1 January 2026. A Maryland reader will assume the fee schedule works differently here — it does not. Global budgets bind hospitals, not physician office billing, so the case for remote physiologic monitoring and principal care management is fully valid at this group. And because one corporate parent owns both the hospitals and this practice, the same entity captures the global-budget savings from every avoided admission and books the Part B care-management revenue. There is no second balance sheet to negotiate with.
Source: the companion CoachCare Value Analysis workbook, MAC locality MD • 12202-01.
And one market note, because it runs the other way here: Montgomery County's Medicare Advantage penetration is 22.57% against roughly 51.7% nationally — about 153,500 beneficiaries county-wide remain in traditional fee-for-service Medicare. Every figure on this page is a fee-for-service figure, and in this county that prices the great majority of the addressable population rather than a minority slice.
This is not a group that needs persuading that protocol-driven, nurse-run, between-visit care works. Its own published services list an anticoagulation clinic, a device clinic, and three modes of ambulatory rhythm monitoring — staffed operations that triage transmitted data every week. The physiologic and care-management layer sitting directly beside that work is simply unstaffed and unbilled.
Plus Holter, event and loop-recorder monitoring. These are protocol-driven chronic-management and transmitted-data-triage operations. The staffing muscle a remote care service line runs on already exists here — what is missing is the reimbursed programme wrapped around it. Practice website retrieved 3 August 2026.
Queried per-NPI from the CMS Medicare Physician & Other Practitioners file for data year 2024, restricted to clinicians whose CMS-reported practice address is a confirmed Cardiac Associates location. That independently corroborates the $5,121,094 a widely used commercial file reports for this account, to within about 2%.
With hypertension at 75.0%, ischemic heart disease at 46.9%, diabetes at 39.0% and an average HCC risk score of 1.472, mean across the ten confirmed clinicians in CY2024. This is the population these benefits were written for — the clinical case does not depend on any commercial argument.
Every resolvable physician here reassigns Medicare billing to the health system's physician-services entity, and all three offices are enrolled practice locations of it. That entity employs 31 of Montgomery County's 133 cardiology clinicians across nine sites — the county's dominant cardiology employer, at roughly 2.4× the largest independent group.
This group is not adjacent to the health system's cardiovascular service line — it is where that service line's clinical leadership sits. Clinicians from this group hold the medical directorships of the Rockville campus's catheterisation laboratory, its electrophysiology laboratory, its chest-pain centre, its inpatient cardiac services and its cardiac rehabilitation programme. The decision, the delivery and the benefit all land inside one organisation.
Maryland is the one state where a reader will assume, reasonably and incorrectly, that a fee-schedule model does not apply. That has to be resolved first, because everything downstream depends on it — and once it is resolved, the state's payment environment turns from an objection into the strongest argument in the account.
The state has operated an all-payer hospital rate-setting arrangement continuously since 1977. The most recent instrument, the Total Cost of Care Model, ended 31 December 2025, and the state moved directly into the AHEAD Model — Achieving Healthcare Efficiency through Accountable Design — as its only Cohort 1 state.
Pre-implementation ran 1 July 2024 – 31 December 2025. Implementation started 1 January 2026; Performance Year 1 runs to 31 December 2026; the model ends 31 December 2035. Cohorts 2 and 3 do not begin performance until 1 January 2028.
Three independent confirmations, none of them inferential. One: the state commission's own scope statement is that it regulates hospital rates — it does not set physician professional fees. Two: CMS describes hospital global budgets as covering inpatient and outpatient services for hospitals; the model's separate physician-facing track is voluntary and limited to primary care, so a cardiology specialty group is neither eligible for it nor bound by it. Three: Maryland physicians appear normally in the CMS Medicare Physician & Other Practitioners file at standard fee-schedule allowed amounts — including this group's own CY2024 figures.
Stated plainly, because a Maryland reader will otherwise assume the opposite: 99453, 99454, 99445, 99457, 99470, 99458 and 99424–99427 are paid under the ordinary Physician Fee Schedule at the Maryland locality. Nothing about the state's arrangement reduces, caps or globally budgets a physician practice's care-management billing.
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. Together they convert the two windows this group generates most of — the days after a cardiac discharge, and the days after an ablation, device implant or catheterisation — from unfunded care into billable events.
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 enterprise 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 two campuses this group works in | No — upside |
| RPM setup | 99453 | ~$20 | Device setup and patient education; requires qualifying data days | Yes |
| RPM device supply | 99454 · 99445 (new) | ~$52/mo | 99454 covers 16–30 days of data; 99445 unlocks the 2–15-day post-discharge and post-procedure window at the same magnitude | Yes |
| RPM treatment management | 99457 · 99470 (new) · 99458 | ~$52 / ~$26 · ~$41 add'l | Monthly review, titration and escalation; 99470 pays the first 10 minutes where the floor had been 20 | Yes |
| Principal Care Management | 99424 · 99425 · 99426 · 99427 | ~$79 / ~$57 · ~$60 + ~$50 add'l | A single high-risk cardiac condition expected to last ≥3 months; 99426–99427 are the clinical-staff workhorse codes | Yes |
Magnitudes shown are national non-facility approximations. The value analysis below uses CY2026 rates auto-resolved by MAC carrier and locality for zip 20850 — MD • 12202-01 — not these national figures.
And the market context cuts the friendly way round here: these are fee-schedule figures, and in Montgomery County only 22.57% of Medicare eligibles sit in a plan where these code families are paid by contract rather than by the fee schedule. That is a footnote in this county, not a load-bearing condition — and it is the reason the modeled figures are close to the whole picture.
The same infrastructure — enrolment, devices, alert triage, escalation, documentation, billing capture — powers each thing the enterprise already cares about.
On most accounts this section names a vendor and prices a connector. Not on this one. No electronic-health-record fingerprint and no patient-portal link of any kind appear anywhere on the group's public site, and because billing runs through the health system's physician-services entity, the operative record may be the enterprise platform rather than a practice-owned one. So this section describes what integration has to do, in terms that hold for any platform — and names the confirmation as the first task in discovery rather than guessing.
Integration capabilities are CoachCare-provided. The value analysis on this page does not assume any particular integration depth.
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 practice 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 199 hospitalizations avoided in the forecast below — and in a global-budget state each one of those is cost the same corporation keeps.
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 practice 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 can be reconstructed end to end — which is what a conversation about readmission performance in a rate-regulated environment actually requires.
A 24-month forecast for a two-programme service line — remote physiologic monitoring and principal care management — across three offices, 15 referring providers, one CoachCare-funded on-site enrolment specialist, and CY2026 rates auto-resolved for MAC locality MD • 12202-01. Transitional care management revenue, avoided-admission value, referral durability and procedural throughput are not in these numbers. Neither is any Medicare Advantage volume. They are upside on top.
| Line | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $861,178 | $2,476,849 | $3,338,027 |
| PCM net reimbursement | $291,329 | $913,039 | $1,204,369 |
| Total net reimbursement | $1,152,508 | $3,389,888 | $4,542,396 |
| CoachCare fees | $669,286 | $1,945,417 | $2,614,703 |
| Practice net (after fees) | $483,222 | $1,444,471 | $1,927,693 |
| Practice margin | 41.93% | 42.61% | 42.44% |
| 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 −$3,683; the first profitable month is month 2. Fee-for-service only. The full model is available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months — on top of the existing procedural, device 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 transmitted data this group's device and rhythm clinics already review every week.
In a global-budget state, that is capacity and cost the hospital keeps rather than revenue it forgoes — and it lands inside the same corporation that books the professional fee.
33,751 care-team hours of monitoring, outreach, escalation and documentation carried by the service line rather than by the group's own staff.
Every figure in this section is priced at fee-for-service rates for MAC locality MD • 12202-01.
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 3,027 enrolled services correspond to 2,356 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 group's physicians govern the protocols and make every clinical decision. Full-service delivery means launch requires no new headcount on the group's side, and the on-site enrolment specialist in the model is funded by CoachCare.
Name the service-line owner, the P&L and the scorecard, and confirm where the decision sits — the group, the medical group, or enterprise population health. Then resolve the three facts that govern the model: the site-of-service status of all three offices (freestanding or provider-based), which record is operative, and whether an enterprise remote-care programme already exists. Confirm the billing configuration for MAC locality MD • 12202-01 and agree the escalation matrix and discharge criteria.
First, the device and rhythm-monitoring population — already conditioned to transmitted data and to a clinic that reviews it. Second, post-discharge cardiac patients on the three-touch cadence with short-window remote monitoring placed at discharge. Stand up the discharge trigger in parallel; it is the piece that has to be designed rather than configured. Validate the panel estimate against the group's own chart counts in the same window.
All three offices enrolling, with the heart-failure and resistant-hypertension panels sequenced first because they carry the largest avoided-admission value. Monthly scorecard — census, capture rate, revenue per patient-month, escalation volume, readmission signal against an unenrolled comparison panel — reporting to service-line governance from month one rather than being asserted later.
A documented post-discharge performance record inside the state's first performance year rather than after it, a readmission signal to put in front of the hospital side of the same corporation, and a standing programme rather than a plan when the CY2027 fee schedule lands.
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 $1,204,369 of the modeled $4,542,396 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 $305,618, RPM accounts for $302,713 and the care-management arm for $2,905.
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.