Guides & references
The rules, written out in plain language.
Everything here exists because we needed it ourselves while building the gates that hold back a non-compliant claim. We name the authority behind each rule so a practice can look it up rather than take our word for it.
Start here
The five pages most practices need.
Revenue calculator
Enter your Medicare panel and an enrolment rate you believe. It models APCM and remote monitoring against published national averages and shows the assumptions rather than hiding them.
Read itAudit posture & the evidence file
What we assemble for each patient-month, which gates hold a claim back, and what a practice would hand a reviewer if asked.
Read itAPCM reference
The three payment levels, the required capabilities, the consent that cannot be inherited from chronic care management, and the single-biller rule.
Read itCCM reference
The twenty-minute floor and what happens when you miss it, the two-chronic-condition eligibility bar, the care plan and consent requirements, and what the active OIG audit is testing.
Read itRemote monitoring reference
Transmission-day thresholds, what counts as a billable device, the live interactive-communication requirement, and why patient-typed numbers never qualify.
Read itField notes
Written analysis, grouped by what it answers.
Longer pieces on the rules that decide whether a month is billable — and on the enforcement activity that makes getting them right worth the effort.
Billing rules
- What APCM actually pays in 2026, and who qualifies for each levelAdvanced Primary Care Management has three levels, no minute thresholds, and one hard consent requirement. Here are the published national rates, the eligibility criteria for each tier, and the tier most practices forget to check for.6 min
- The 16-day rule, and the new code for the months you miss itRPM device supply is paid on distinct transmission days, and fifteen days is not ninety-four percent of sixteen — it is a different code. What counts as a transmission day, what does not, and how the 2–15 day tier changes the arithmetic.4 min
- APCM or CCM: how to choose, patient by patientThey are mutually exclusive in the same month for the same patient, and the right answer differs across your panel. A framework for deciding, and the reason most small practices should start with APCM even when CCM pays more on paper.4 min
Audit risk
- OIG found 43% of RPM enrollees didn't get what was billed. Read it before you scale.The September 2024 HHS-OIG review of Medicare remote patient monitoring is the single most important document for any practice billing this program. What it found, what it recommended, why the recommendation still being open matters, and what a defensible month looks like.4 min
- Consent for APCM and RPM: the requirements, and the four ways practices fail themConsent is the cheapest compliance artifact to get right and one of the most common to get wrong. What must be disclosed, why an inherited CCM consent doesn't work, and the sequencing that determines whether your program survives month two.5 min
Everything above is published analysis of federal rules, not legal, regulatory, coding, or billing advice. Rates are national averages and vary by locality. Browse all field notes chronologically.
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