CMS is quietly reshaping how primary care teams can be paid for mental and emotional health support. Starting in 2026 (if finalized), practices using the new Advanced Primary Care Management (APCM) codes will be able to add small, monthly payments for behavioral health integration...
If your practice adopted APCM by shutting down RPM and RTM programs, you left money on the table. If you're running all three programs separately, you're burning cash on duplicate documentation and exposing yourself to compliance risk...
On January 1, CMS introduced a brand-new benefit called Advanced Primary Care Management (APCM), a monthly payment designed to roll up the core elements of care coordination under a single code. For primary care leaders, this changes the landscape in profound ways. APCM overlaps with Chronic Care Management (CCM)...
This document outlines a groundbreaking proof of concept for reimagining medical ontologies and artificial intelligence. Buffaly demonstrates how large language models (LLMs) can unexpectedly enable symbolic methods to reach unprecedented levels of effectiveness. This fusion delivers the best of both worlds: completely transparent, "white box" systems capable of autonomous learning directly from raw data...
Advanced Primary Care Management (APCM) represents one of the more meaningful changes in the CMS Physician Fee Schedule. As of January 1, 2025, practices that adopt this model will be reimbursed through monthly, risk-stratified codes rather than only episodic, time-based billing...
Primary care is carrying more risk, more responsibility, and more expectation than ever. The opportunity is that we finally have a model that pays for the work most teams already do between visits. The risk is jumping into tooling and tactics before we agree on the basics....
The Federal Trade Commission’s Sept. 12 warning to healthcare employers is a simple message with real operational consequences. Overbroad noncompetes, no‑poach language, and “de facto” restraints chill worker mobility and can limit patients’ ability to choose their clinicians. For practices building Advanced Primary Care Management teams, restrictive templates do more than create legal risk...
Advanced Primary Care Management represents Medicare's most ambitious attempt to transform primary care economics. Unlike previous programs that nibbled at the margins, APCM fundamentally restructures how practices organize, deliver, and bill for comprehensive care...
Advanced Primary Care Management (APCM) is Medicare’s newest program, introduced in 2025 with three billing codes: G0556, G0557, and G0558. This represents a pivotal shift toward value-based primary care by offering monthly reimbursements for delivering continuous, patient-focused services. You're already providing these services—why not get paid for it?
At 2 AM, a new mother in rural Alabama feels her heart racing. She's two weeks postpartum, alone with a newborn while her husband works the night shift. Her blood pressure reading on the home monitor shows 158/95. Within minutes, her care team receives an alert. By 6 AM, a nurse has called, medications are adjusted, and what could have been a stroke becomes a story of crisis averted.
Many health systems pay full-service RPM vendors $40–$80 PMPM for services they can in-source for far less. With 2025 Medicare rates and OIG scrutiny, it's time to revisit the build-vs-buy math.
A few months ago, a physician at a 12-doctor practice in rural California called me frustrated. His practice was hemorrhaging money on readmissions, his nurses were burning out from phone tag with chronic disease patients, and his administrator was getting pressure from...
Medical executives today face an uncomfortable reality: while navigating shrinking margins and mounting operational pressures, many are unknowingly surrendering millions in Medicare reimbursements to third-party vendors. The culprit? Poorly structured Remote Patient Monitoring (RPM), Chronic Care Management (CCM)...
Remote Patient Monitoring (RPM) has rapidly evolved from emerging healthcare innovation into a strategic necessity. Driven aggressively by CMS reimbursement policies, RPM adoption has accelerated at unprecedented rates...
In a single December blog post, CMS just rewrote the playbook for $400 billion in annual Medicare Advantage spending. The termination of the Medicare Advantage Value-Based Insurance Design...
If you've spent any time managing a remote patient monitoring (RPM) program, you already know the drill: juggling the 16-day rule, keeping track of clinical minutes, chasing compliance, and often wondering if this is really what patient-centered care was meant to feel like...
Let’s be honest. Managing your health today feels like trying to coordinate a group project where nobody checks their messages. Your cardiologist, endocrinologist...
The healthcare industry still has scars from the ICD-9 to ICD-10 transition. The stories are legendary in Health IT circles: coder productivity plummeting, claim denials surging, and revenue cycles seizing up for months. It was a painful lesson in underestimation...
In my work with healthcare organizations across the country, I see two distinct patient profiles coming into focus. They represent the past and future of remote care, and every successful practice must now build a bridge between them...
The healthcare landscape is continuously evolving, and among the most profound shifts emerging is the concept of the Digital Twin for Patients. This technology isn't merely an abstract idea...
Change is inevitable in healthcare. Often, it feels overwhelming—but occasionally, a new shift arrives that genuinely makes things simpler...
It starts with a data spike… a sudden drop in movement, a rise in reported pain. The alert pings the provider dashboard, hinting at deterioration. But what if that signal isn’t telling the whole truth
Chronic pain isn’t just a condition, it’s a thief. It steals time, joy, and freedom from over 51 million Americans, according to the CDC, costing the economy $560 billion a year. As someone passionate about healthcare innovation, I’ve seen how this silent struggle affects patients, families, and providers...
Picture Mary, 62, balancing a job and early diabetes. Her doctor, Dr. Patel, is her anchor—reviewing labs, coordinating with a nutritionist, tweaking her care plan. But until 2025, Dr. Patel wasn’t paid for this invisible work...
In healthcare, most of the time, trouble doesn't announce itself with sirens and red flags. It starts quietly. A free dinner here. A paid talk there. An event that feels more like networking than education...
The Office of Inspector General’s (OIG) 2024 report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), isn't just an alert—it's a detailed playbook exposing critical vulnerabilities in Medicare’s Remote Patient Monitoring (RPM) system...
When the Department of Justice announces settlements, many of us glance at the headlines and move on. Yet, behind those headlines are real stories about real decisions...
There’s a quiet agreement most of us make in business. It’s not in a contract. It’s not written on a whiteboard. But it runs everything: trust...
Feeling like you’re drowning in regulations designed by giants, for giants? If you're running a small practice in today's healthcare hellscape, it damn sure feels that way...
When people ask me what Intelligence Factory does, they often expect to hear about AI, automation, or billing systems. And while we do all those things...
“They’re going to put me out of business. They want over a million dollars. I don’t have a million dollars”, his voice cracked over the phone...
RPM (Remote Patient Monitoring) CPT codes are a way for healthcare providers to get reimbursed for monitoring patients' health remotely using digital devices...
AWS machine learning enhances MEDEK telemedicine solution to ease gender bias for sensitive online doctor visits...