In Grant County, two of every three Medicare patients are on Original Medicare. Since January, Medicare pays a provider-based rural health clinic for the month of care between visits as its own codes, at national amounts, on top of every encounter. The district already runs the clinics, the Epic chart and a brand-new hospital; what it does not have yet is a revenue line for the days between visits. This is the 24-month plan, inside Epic, with CoachCare staffing the program.
Two counts, two jobs. 885 patients are in active remote care at month 24; the enrollment chart and the Scenario Explorer show 1,358 program enrollments, because a patient on both remote monitoring and a care-management program is one patient and two enrollments. $1,001,143 of the $2,356,382 is the district's after CoachCare's fees.
A community-owned public hospital district in Moses Lake, governed by elected commissioners, that runs a 50-bed acute-care hospital and two rural health clinics across the Columbia Basin. In March 2026 it opened a new $225 million replacement hospital, closing a decade-long capital cycle. Care already reaches across a wide rural service area, on the Epic chart the whole organization runs. What it does not have yet is a Medicare revenue line for the month between visits.
Both clinics are Medicare-certified rural health clinics owned by the same public hospital district. That status is what lets the district bill the care-management codes on this page at the national amounts, on top of the encounter rate, the moment it enrolls a patient.
Grant County runs 33.6% Medicare Advantage, so about two-thirds of the county's Medicare is Original, fee-for-service Medicare. On that share the codes on this page pay per claim without a plan contract in the way. The traditional-Medicare base is a strength here, not a footnote.
The new hospital opened in March 2026. The next move does not need a building or a bond. A remote care service line generates margin in-year on staff and infrastructure that are already in place, which is exactly the kind of operating line a district looks for right after a capital cycle.
The district has run on Epic since about 2021, with MyChart for patients. A remote care program that lives inside the Epic environment the team already opens is the right one to be paid for the month between visits, with nothing new for clinicians to learn.
One structural fact completes the picture: no remote patient monitoring, chronic care management or advanced primary care management program is in evidence at scale — current-state telehealth is visit-based, over MyChart and video. A provider-based rural health clinic's care-management billing rides an institutional claim, so it would not show in the physician fee-schedule data regardless, which is why the honest statement is that there is no program in evidence rather than a count of zero. The patients with hypertension and diabetes are seen a few times a year. Between those visits there is no revenue line yet.
Two things changed for a provider-based rural health clinic: how care management is billed, and what remote monitoring can bill for. Together they open a Medicare revenue line on a panel the district already sees.
Through 2025, a rural health clinic billed care management as one bundled code, G0511. Since January 2026, it bills chronic care management, remote monitoring and advanced primary care management as individual codes at the national non-facility amounts, in addition to the encounter rate. Each service is paid on its own, every month it is delivered. The figures on this page are priced at the national amounts a rural health clinic is paid for these codes.
New 2026 codes for 2 to 15 days of device data and for the first 10 minutes of management remove the 16-day floor that used to block episodic monitoring. A patient discharged from Samaritan Hospital, the district's own 50-bed hospital, can now be followed through a billable two-week window, next to the standard monthly stack. That discharge is a real inpatient or observation discharge, so the short window is legitimate here in a way most rural clinics cannot claim.
Advanced primary care management pays a flat monthly amount by tier: $16.37, $53.78 and, for a patient who is a Qualified Medicare Beneficiary, $117.24. On this forecast the tier mix blends to $62.16 per patient-month, paid for keeping the primary-care relationship active. The top tier is the dual-eligible tier, and a safety-net panel skews toward it. The enrollment and engagement labor that earns it is CoachCare's.
A named service line with its own P&L and scorecard, following the Medicare patients the district already knows, inside the Epic chart it already runs. Remote monitoring for the conditions that produce readings, chronic care management for patients with two or more conditions, and advanced primary care management for the primary-care relationship itself.
| Service | Codes | CY2026, national non-facility | Use across the panel |
|---|---|---|---|
| RPM setup and device supply | 99453 · 99454 · 99445 (new) | $21.71 setup · $52.11/mo | Hypertension and diabetes cohorts; 99445 opens 2–15-day windows after a discharge |
| RPM treatment management | 99457 · 99458 · 99470 (new) | $51.77 + $41.42 add'l · $26.05 | Monthly review, titration, escalation |
| Chronic care management | 99490 · 99439 | $66.13 + $50.44 add'l | Two or more chronic conditions; the longitudinal wrapper |
| Advanced primary care management | G0556 · G0557 · G0558 | $16.37 · $53.78 · $117.24/mo | The primary-care panel by complexity tier; the top tier is the dual-eligible tier |
| Transitional care management | 99495 · 99496 | Per discharge | Discharges from Samaritan Hospital, the district's own hospital; named as the discharge wedge, not in the forecast below |
Amounts are the CY2026 Medicare physician fee schedule national non-facility rates, the rail a provider-based rural health clinic bills the care-management codes on in addition to the encounter rate, and the basis every figure on this page is priced on. The local Washington locality prices above national; national is the conservative and correct basis.
Three things line up in the same twelve months: the capital cycle just closed, a state funding line is about to open, and the district is already carrying two-sided risk. A remote care service line answers all three at once.
CMS awarded Washington roughly $181 million for year one of the Rural Health Transformation Program. The state's plan funds a provider technology line for telehealth, remote monitoring and population-health analytics, and names rural health clinics and rural hospitals among the eligible organizations. First funds distribute October 1, 2026. It is a near-term, state-administered budget line that maps almost exactly to this tooling. This page presents it as an opportunity to pursue, not a secured award.
The district is in an Enhanced-track, two-sided-risk Medicare Shared Savings ACO with prospective assignment, in its first performance year. Because assignment runs on primary-care service codes, documented monthly care management holds beneficiary attribution and strengthens total-cost-of-care performance. That means shared-savings upside and downside protection, both on top of the fee-for-service revenue on this page. The value model here is fee-for-service; the ACO economics are not modeled.
The $225 million replacement hospital is open and the capital cycle is closed. This service line needs no building, no bond and no new clinic hires. It generates margin in-year on staff and infrastructure already in place, and it diversifies revenue toward fee-for-service Medicare at a moment when Medicaid exposure is under pressure.
A 24-month forecast for the RPM + CCM + APCM stack: an estimated 3,000 Medicare patients, all of them in scope from month one, 24 referring clinicians plus CoachCare's enrollment outreach, the national amounts a rural clinic is paid, and the Epic integration. Transitional care and Washington Apple Health are not in these numbers.
After denials and coinsurance bad debt; $869,817 in Year 1 and $1,486,565 in Year 2.
42.49% of net reimbursement after CoachCare's fees: 41.80% in Year 1, 42.89% in Year 2.
Unique patients in active remote care at month 24; the panel is full by month 13, so month 12 and month 24 sit close together.
RPM 683 + CCM 360 + APCM 315 active enrollments at month 24.
| Program | Net reimb. | CoachCare fees | Net to district |
|---|---|---|---|
| RPM | $1,169,762 | $671,429 | $498,332 |
| CCM | $792,711 | $403,983 | $388,728 |
| APCM | $393,909 | $220,987 | $172,923 |
| Implementation, Epic integration, outreach | — | $58,840 | −$58,840 |
| 24-month total | $2,356,382 | $1,355,239 | $1,001,143 |
| Enrollment outreach, care management and device logistics are CoachCare's expense: embedded in the fee, never a separate charge to the district and never deducted from its margin. | |||
| Year | Net reimb. | CoachCare fees | Net to district | Margin |
|---|---|---|---|---|
| Year 1 | $869,817 | $506,205 | $363,612 | 41.80% |
| Year 2 | $1,486,565 | $849,033 | $637,532 | 42.89% |
| 24 months | $2,356,382 | $1,355,239 | $1,001,143 | 42.49% |
Recurring care-management and monitoring volume over 24 months, filed by the district's own billing team.
Blood pressure, weight and glucose, a continuous picture of the hypertension and diabetes cohorts between visits.
About $1,199,000 in acute-care cost that never gets spent, at $15,000 per admission.
About 15,970 care-team hours of monitoring, outreach and documentation carried by the service line, not by district staff.
APCM reaches its ceiling of 315 enrollments in month 5, CCM its ceiling of 360 in month 8, and RPM its ceiling of 683 in month 13. From there the census holds at 1,358 program enrollments, 885 patients. The binding constraint on this forecast is the size of the Medicare panel, not enrollment capacity and not clinician count. The first 90 days, modeled: 71 new enrollments in month 1, 118 in month 2, 166 in month 3.
| Program | Ceiling | How it is defined | Reached |
|---|---|---|---|
| RPM | 683 | 3,000 in scope × 65% eligible (1,950) × 35% acceptance | Month 13 |
| CCM | 360 | 3,000 × 40% (1,200) × 30% | Month 8 |
| APCM | 315 | 3,000 × 35% (1,050) × 30% | Month 5 |
| At month 24 | 1,358 | Program enrollments = 885 patients | — |
Every ceiling above is reached with one CoachCare-funded on-site enrollment specialist working the clinics. Without that specialist, RPM, the largest program, reaches its ceiling in month 18 instead of month 13, and 24-month net reimbursement falls to $2,104,390. The specialist cannot raise a ceiling. Reaching it months sooner is worth $251,992 over 24 months, and it is CoachCare's payroll, not the district's.
Because every program fills inside the first year, the number that moves this forecast is the Medicare panel itself. The 3,000 patients here is a careful estimate; a provider-based rural health clinic's Medicare encounters are billed institutionally, so the panel does not show in the physician fee-schedule data, and the district's own count by clinic is discovery item one. At the low end of the credible range, 1,800 patients, the program is $1,544,155 of 24-month net reimbursement; at 4,500 it is $3,125,875. The forecast moves nearly one-for-one with the panel.
About four in ten of the district's patients are on Washington Apple Health, the state Medicaid program, and that book is under federal-cut pressure. The remote care service line diversifies revenue toward fee-for-service Medicare, which is exactly why the Medicare rail on this page is the one modeled. Apple Health remote care is real, but it pays on different terms.
The point of the service line is the between-visit revenue Medicare already pays a rural health clinic for. The Apple Health panel is where the clinical need is largest, and it is the reason to have the monitoring infrastructure in place when a plan arrangement opens.
The district runs on Epic, and this plan is priced on CoachCare's direct, bi-directional Epic integration. The whole program lives in the Epic environment: enrollment flags and orders are placed inside the clinical workflow; device readings land as discrete vitals in the chart, not PDFs; audit-ready documentation posts to the record; claims are generated automatically; and the district's own billing team files them. Patients begin receiving CCM and RPM services in under five days from the flag.
A clinician flags an eligible patient and places the trigger order inside the Epic workflow, the way a lab order is placed. CoachCare picks it up, ships the device and reaches the patient.
Readings, calls and care-plan work happen on CoachCare's platform and care team, with the escalation pathway below routing anything that needs a clinician.
Device readings land as discrete vitals, and the care summary, the care plan and enrollment status post to the Epic record. One chart, no second system for clinicians.
Claims are generated automatically with the care-management codes on them, and the district's own billing team files them. CoachCare is the only care-management platform with automated Epic claim creation, which removes the manual claim step per patient per month.
The district's clinicians set the thresholds and own every clinical decision. CoachCare's care team works the readings and the calls between visits and routes each finding one of three ways. The thirty days after a discharge from Samaritan Hospital get a fixed three-touch cadence, because that is where an admission repeats.
Any hospitalization or observation stay in the last 60 days triggers three touches inside two weeks. It is also the TCM episode: contact within two business days, the visit within 7 or 14 days, and a device in the home before the first follow-up. Samaritan Hospital is a real certified hospital the district owns, which is what makes this loop legitimate here.
Reach the patient, reconcile medications against the discharge instructions, confirm the device is transmitting.
Symptom and reading review, barriers to the plan, follow-up appointment confirmed with the clinic.
Close the episode or extend it; anything trending is escalated through the engine below.
Chest pain, new shortness of breath, stroke signs, syncope, worst-ever headache, sudden swelling. CoachCare's urgent and emergent policy supersedes any client-specific preference, on any day. If the patient refuses, the clinic is notified; otherwise CoachCare activates 911.
Out-of-range but not emergent findings route to the clinician or nurse the district designates, with the readings, the symptom check and the recommended next step attached.
A retake that lands in range and a symptom check that is clean closes the loop with a chart note and nothing else. The clinic's inbox is reserved for what needs a decision.
An unreachable patient is re-attempted on a set cadence, the clinic is notified at every decision point, and a patient who stops transmitting is worked before a billing month is lost.
Moses Lake sits at the center of a wide rural service area, where the distance between a patient's home and the clinic is itself the barrier to staying on a plan. About 45% of the county is Hispanic, and home connectivity is not a given. A program that works here has to travel without assuming broadband and speak the patient's language. Six design decisions follow.
Every cuff, scale and glucometer ships with its own cellular connection and transmits on its own. No smartphone, no home internet, no rural broadband, no app to install. The device works the day it comes out of the box, which matters most across a service area where connectivity is uneven.
A daily reading from home is a touch that did not require a long drive across the Basin. For a housebound or transport-limited patient, the monthly contact is the difference between a managed condition and one that is only seen when it lands in the emergency department.
Device instructions and call scripts in both languages, matched to the language on the patient's chart. With about 45% of the county Hispanic, bilingual care management is built in from the first cohort, not added later.
Samaritan Hospital discharges flow straight into the post-discharge cadence and the transitional-care window. Because the district owns the hospital and the clinics, the handoff from an inpatient bed to a monitored home is one organization's decision, not a referral out.
Lists come from the hypertension and diabetes cohorts first, then by clinic and payer, so the Medicare rail fills where the fee-for-service panel is and the two clinics are enrolled on their own timelines rather than as one blended number.
Care managers, enrollment outreach and device logistics are CoachCare's payroll. In a workforce-constrained rural market, the labor the program needs is the labor the district does not have to recruit, and the clinicians govern it under general supervision.
Grant County's Medicare book is majority Original Medicare, which is the billable base for the codes on this page. The county carries a real chronic-disease burden and a large safety-net population, and the remote care engine earns its keep for both reasons: the codes pay per claim on the fee-for-service majority, and the same infrastructure is what a two-sided-risk ACO needs to hold attribution.
CMS has proposed cutting the remote-monitoring device-supply codes for CY2027. The proposals are narrower than the headline. Here is what they do to the forecast on this page, repriced at the national amounts a rural health clinic is paid, the same basis the forecast itself uses.
The proposals reach the remote-monitoring family only. Chronic care management and advanced primary care management are not in them, and on this forecast those two carry $1,186,620 of the $2,356,382 in 24-month net reimbursement. Their own amounts move by a point or two through conversion-factor and RVU churn, so $19,941 of the $131,262 total sits outside the remote-monitoring arm.
Two contingencies are already in build. An unbundled arrangement, with the software platform, device logistics and program enablement priced separately, and an arrangement in which CoachCare manages the staffing while the district owns the clinical program and the billing. Whichever way the final rule lands, the program does not have to be rebuilt.
CMS is moving remote care toward payment for results: per-member-per-month amounts with a share withheld and reconciled against outcomes. Fee-for-service code cuts and that shift are the same policy argument, and it is the same argument as a two-sided-risk ACO. A consented, documented, monthly-managed panel with continuous readings is what every version of that payment rewards, and this service line builds that panel under fee-for-service first.
Three numbers, each smaller than the last, because each one sits on a larger base. Both bars are drawn on one shared dollar scale, so the orange can be compared directly across them.
24-month net reimbursement, CY2026 final versus CY2027 proposed, every code repriced at the national non-facility amounts on this forecast's own billing mix and APCM tier weights. Enrollment, acceptance and mix held constant. This is the rate change alone.
National non-facility amounts from the proposed rule's Addendum B. A provider-based rural health clinic bills the care-management codes on this rail, so the table and the repricing above sit on the same basis and reconcile to the dollar.
| In scope: remote monitoring | ||||
|---|---|---|---|---|
| Code | What it pays for | CY2026 | CY2027 | Change |
| 99453 | Setup and patient education | $21.71 | $20.03 | −7.7% |
| 99445 | Device supply, 2–15 days | $52.11 | $41.38 | −20.6% |
| 99454 | Device supply, 16–30 days | $52.11 | $41.38 | −20.6% |
| 99457 | Treatment management, first 20 minutes | $51.77 | $49.59 | −4.2% |
| 99458 | Treatment management, each additional 20 minutes | $41.42 | $40.39 | −2.5% |
| 99470 | Treatment management, first 10 minutes | $26.05 | $20.69 | −20.6% |
| Not in scope: care management | ||||
| 99490 | Chronic care management, first 20 minutes | $66.13 | $64.04 | −3.2% |
| 99439 | Chronic care management, each additional 20 minutes | $50.44 | $49.92 | −1.0% |
| G0556 | Advanced primary care management, level 1 | $16.37 | $16.09 | −1.7% |
| G0557 | Advanced primary care management, level 2 | $53.78 | $53.20 | −1.1% |
| G0558 | Advanced primary care management, level 3 | $117.24 | $116.91 | −0.3% |
The device-supply and short-treatment codes are held to a one-year maximum reduction by section 1848(c)(7) of the Act, which phases any decrease of 20 percent or more over two years. CY2027 is the capped year; the remainder of the crosswalk lands no earlier than the year after.
The comment period on CMS-1848-P closed September 14, 2026. The final rule publishes in early November 2026 and takes effect January 1, 2027. CoachCare is leading advocacy on the remote-monitoring provisions and will rerun this forecast against the final rates the week they publish.
CoachCare operates as the service line's engine while the district's clinicians govern protocols and every clinical decision. Launch needs no new clinic headcount and no capital; the Epic integration runs in parallel with onboarding, and the first enrollments follow the first orders.
Epic integration scoped and started; named program lead at the district; P&L and scorecard; claim configuration with the billing team; protocol sign-off for the hypertension and diabetes pathways; the bilingual outreach rules loaded; the discharge trigger from Samaritan Hospital wired to the three-touch cadence.
APCM across the primary-care panel, CCM across the two-plus-condition panel and RPM for the hypertension and diabetes cohorts, one clinic first; CoachCare's on-site bilingual enrollment specialist working the point of care; the post-discharge cadence live from day one.
APCM fills in month 5, CCM in month 8, RPM in month 13; monthly scorecard to district leadership, with the blood-pressure and diabetes control measures the ACO already cares about.
Bring the second clinic fully online, take up the Apple Health question with the plans, bring transitional care to every Samaritan Hospital discharge, and extend the same infrastructure toward the ACO's total-cost-of-care goals.
A remote care service line is a clinical operation that happens to bill. Software companies hand back the care team, staffing companies hand back the technology, device companies hand back the billing, and a multi-vendor stack fails at the seams. In a rural district, the seams are distance, connectivity and a workforce that is already stretched. One partner has to carry the whole set.
Platform, proprietary cellular devices and SIMs, end-to-end device logistics, a US-based W-2 care team, the billing engine and the analytics layer, built and run by CoachCare. Devices arrive configured and paired, transmitting over cellular with no smartphone, app or home internet, which is what makes the program work across the Columbia Basin instead of Moses Lake only.
Over 500,000 patients managed across more than 400 conditions, with more than 1,000 programs stood up and running. Hypertension and diabetes, the daily work of a rural primary-care panel, are the conditions the platform and the care team are built around.
Readings land as discrete vitals, care-plan time and documentation post to the record, and claims generate automatically into the chart the district already opens. CoachCare is the only care-management platform with automated Epic claim creation, so the program is live in the environment the team knows, not bolted on beside it.
No upfront capital, no hiring plan, no device purchase. The district bills under its own numbers and keeps the payer relationship and the revenue. A care team staffed to the district and trained on its protocols works at about a 160:1 ratio rather than the 300:1 common in the market, with bilingual outreach at the point of care because telephonic outreach alone converts in the single digits. Only two things rise back to a district clinician: the exceptions, and the claim.
The consented, documented, monthly-managed panel this service line builds under fee-for-service is the same panel that holds beneficiary attribution and drives total-cost-of-care performance in your Enhanced-track ACO. It is also the panel that positions the district for the Rural Health Transformation funding and for the results-based payment CMS is moving toward. One infrastructure, several returns.
Over 400 managed conditions across the platform.
Providers running remote care programs day to day.
Care-plan coding and billing behind more than 5 million claims.
With 4 million+ care actions enabled.