Scope for each practice is confirmed in the engagement agreement, including systems, payers, and queues.
Programs fail in the log, not in the slogan
Practices sign a quality program and then never bill the monthly care-management code because consent, time, or the initiating visit was not captured. Or they bill it and refund a year later. The work is closer to charge capture than to a strategy retreat. It needs a roster, a clock, and a person who knows which code the documentation can carry.
What the work includes
- Inventory of programs and care-management codes the practice intends to use
- Checks for consent, initiating visit, and time documentation where a code requires them
- Roster hygiene for attribution files the practice already receives
- Separation of program reporting from ordinary claim submission
- Queries when a note describes care coordination that was never timed
- A monthly view of which codes were supported and which were held
How the work moves
Step 1
List the programs actually in force
A brochure is not an enrollment. We start from agreements and payer portals the practice can open.
Step 2
Match codes to evidence
Time-based and staff-based codes are billed only when the log and the consent match the code definition. Gaps are held.
Step 3
Keep rosters boring and accurate
Deaths, payer changes, and patients who declined are removed. Attribution arguments are documented, not assumed.
Step 4
Report activity, not a projected bonus
Leaders see what was billed and what was held. Any shared-savings figure belongs to the payer's report, not to a marketing estimate.
Operational benefits
- Care-management codes that can survive a review
- Fewer missed initiating visits
- Cleaner rosters for the programs the practice already joined
- A clear line between fee-for-service billing and incentive payments
Common challenges
- Code definitions and eligible clinicians change
- Time logs that are reconstructed at month end are weak evidence
- Attribution is the payer's methodology
- Quality measures can depend on data the billing system does not hold
Technology
Time tracking may live in the EHR, a care-management module, or a spreadsheet. The assessment says which one is the record of truth. We do not claim a proprietary quality-scoring platform.
Where specialty changes the work
Primary care, internal medicine, and some specialties with chronic panels use these codes most. The primary care page describes the visit types. This service describes the program mechanics.
Questions
Can you estimate our shared-savings payment?
No. Those payments depend on a payer contract and a measurement year we do not control. We can account for the codes and logs that are in the practice's hands.
Is a care-management code free money for existing staff?
Only when the time, consent, and clinical staff rules are met. Billing the code for work that was not documented is a refund risk.
Do you run a population-health product?
No. This is operational billing support around programs the practice has already joined or chooses to join.