Ten physicians, three offices, and a Medicare panel where the nephrologists' patients carry an average risk score between 3.6 and 4.5, chronic kidney disease and hypertension at the ceiling CMS publishes to, and a third on Medicaid as well. The practice already runs a monthly, protocol-driven relationship with its dialysis patients. This is that discipline extended to the months between nephrology visits for everyone else: transitional care at discharge, remote blood-pressure and weight monitoring, and principal care management, staffed and run by CoachCare inside eClinicalWorks, with the practice keeping 42.6% of net reimbursement over 24 months.
Year 1 margin 40.5%, Year 2 43.6%. Enrollment begins in month 1; month 1 runs −$5,495 while setup posts against a small census, and the practice is positive from month 2 onward. The headline is 593 unique patients; the enrollment chart shows 906 active program enrollments, because a patient on both programs is one patient and two enrollments.
The practice's own CY2024 Medicare claims show one of the highest-acuity panels a specialty group can carry, a monthly management habit already in place for its sickest patients, and a precise line where that habit stops.
$2.46M of Medicare allowed across 17 billing clinicians in CY2024, against a national average risk of 1.00. Chronic kidney disease and hypertension both report at 75%, the ceiling CMS publishes to; diabetes 60–69%; heart failure 45–67%. 32% of the panel is dual-eligible. About 1,400 established patients were seen for a follow-up office visit in the year.
Every in-center dialysis patient is seen on a fixed cadence, documented against a protocol and billed once a month under the ESRD monthly codes. Six clinicians also coded the G2211 longitudinal-complexity add-on on 810 patients. The practice already runs a monthly, protocol-driven relationship with its highest-risk patients. It stops at the dialysis chair.
99453, 99454, 99457, 99458, 99490, 99424–99427 are absent from the CY2024 claims for every clinician: no program at meaningful scale. Transitional care management was billed for 15 patients by one clinician. On a panel where three in four patients carry chronic kidney disease, none of the monthly management work between quarterly visits is being billed.
Subsequent hospital care alone ran 8,503 services across 2,606 patients in CY2024, and inpatient work is about 48% of everything the practice bills to Medicare. The practice's physicians round at four hospitals. Each of those patients leaves the building at some point, and in CY2024 the transitional-care codes followed 15 of them.
The thirty days after a kidney patient's discharge are where the next admission is decided: a fluid gain of three pounds in a day, a potassium that drifts on a new diuretic, a blood pressure that never settled. That window is what this service line is built around: contact within two business days, a visit inside 7 or 14 days, a cuff and a scale transmitting daily, and a nurse who sees the weight move on Tuesday and reaches the nephrologist before Friday. Transitional care pays $205.94 and $279.41 per discharge at this locality, and it is not in the forecast below.
| Where the CY2024 Medicare work sits | Share of allowed | What follows it today |
|---|---|---|
| Hospital care (initial, subsequent, discharge day, inpatient dialysis) | 48% | 15 transitional-care episodes |
| Dialysis monthly capitation (in-center and home) | 28% | A monthly protocol, already run |
| Office visits (new and established) | 13% | The next quarterly visit |
CY2024 Medicare Physician & Other Practitioners file, the practice's 17 billing clinicians. Shares are of Medicare allowed amounts; the remainder is nursing-facility care, procedures and other services.
The ESRD Treatment Choices model that covered the Lafayette hospital referral region ended on December 31, 2025. The Kidney Care Choices model runs through 2027, and CMS has said it is designing a successor. Two independent nephrology groups in the region already sit inside a kidney care entity. Acadiana Renal Physicians participates in none of these today, and nothing on this page assumes it will. Every one of those doors asks for the same four things: a consented longitudinal panel, documented monthly care management, continuous physiologic data, and a working readmission-prevention loop. This service line builds all four under fee-for-service, before any deadline exists.
At the model's generic 20% annual admission rate. A stage 3b–5 kidney panel with heart failure in half its patients admits well above that; at 40% the figure is about 120.
At $15,000 per admission. None of it is in the Value Analysis below, which prices the fee-for-service codes only. Under any total-cost arrangement, this is the number that is scored.
Volume and blood-pressure control between visits slows progression, and a patient whose decline is watched monthly reaches dialysis with an access placed and a modality chosen rather than through the emergency department. That is the outcome every kidney model, current or next, pays on.
Three billing families, one clinical workflow, one care team. A patient enters wherever they are, coming out of the hospital, newly uncontrolled, or overdue for real between-visit management, and stays on the same pathway until the next nephrology visit and beyond.
Novitas, Louisiana locality 99, the rates all three offices resolve to.
| Code | What it covers | CY2026 rate | Cadence |
|---|---|---|---|
| 99496 | Transitional care management, high complexity, face-to-face within 7 days | $279.41 | Once per discharge |
| 99495 | Transitional care management, moderate complexity, within 14 days | $205.94 | Once per discharge |
| 99453 | Remote monitoring, patient set-up and education | $19.26 | Once per episode |
| 99445 | Device supply, 2–15 days of readings (new for CY2026) | $46.14 | Short window |
| 99454 | Device supply, 30 days of readings | $46.14 | Monthly |
| 99470 | Monitoring management, 10–19 minutes (new for CY2026) | $24.30 | Monthly |
| 99457 | Monitoring treatment management, first 20 minutes | $48.26 | Monthly |
| 99458 | Monitoring treatment management, each additional 20 minutes | $39.09 | Monthly |
| 99426 | Principal care management, clinical staff, first 30 minutes | $64.02 | Monthly |
| 99427 | Principal care management, each additional 30 minutes | $50.74 | Monthly |
CY2026 Physician Fee Schedule non-facility amounts for ZIP 70506 (Novitas, Louisiana locality 99), the basis the Value Analysis below is priced on.
The practice already meets patients on healow, eClinicalWorks' patient platform. CoachCare integrates natively with eClinicalWorks. Enrollment flags and orders leave the chart; vitals, care documentation, enrollment status and billing-ready claims come back into it. Clinicians stay in the chart they already use, and the practice's biller does not learn a new claim path.
Enrollment flags and ordering by service inside the eCW workflow; the on-site specialist works the list, and patients begin receiving services within days.
Evidence of care, vitals and care plans attach to the patient's chart monthly, which is what makes the time-based claim defensible under audit.
The CoachCare billing engine creates the claim for every enrolled patient every month, removing the manual claim step the practice's billing manager would otherwise carry.
Integration setup for eClinicalWorks runs $4,000 one time, with a $150 monthly interface fee and $1.50 per enrolled patient per month. Those figures are carried in the financial summary below; the integration scope is confirmed with the practice in contracting.
The Value Analysis shows the program pays. This is the part that says it is safe, and that ten physicians see signal rather than a thousand readings a day.
Chest pain, new shortness of breath, stroke signs, syncope, sudden swelling, a blood pressure at crisis level. CoachCare's urgent and emergent policy supersedes any practice-specific preference. 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 practice designates in the charter, with the readings, the symptom check and the recommended next step attached.
A retake that lands in range and a clean symptom check closes the loop with a chart note and nothing else. The nephrologist's inbox is reserved for what needs a decision.
An unreachable patient is re-attempted on a schedule, the practice is notified at every decision point, and a patient who stops transmitting is worked before a billing month is lost.
Any emergency visit or hospitalization in the preceding 60 days triggers three touches inside two weeks, and when the patient was admitted it is also the TCM episode. That cadence, on this panel, is where the modeled 60 avoided hospitalizations over 24 months come from.
Reach the patient, reconcile medications and diuretics against the discharge instructions, confirm the cuff and scale are transmitting.
Weight and blood-pressure trend reviewed, diuretic plan and lab timing confirmed, follow-up appointment confirmed with the practice.
Close the episode or extend it; anything trending is escalated through the engine above.
A 24-month forecast for the RPM + PCM stack: 1,750 Medicare patients in scope for Year 1 out of an estimated panel of 1,750, sized from the practice's own CY2024 established-visit beneficiaries and the Medicare Advantage share of Lafayette Parish. 11 referring clinicians, one CoachCare-funded on-site enrollment specialist, Louisiana locality 99 rates and the eClinicalWorks integration. Transitional care and the dialysis monthly codes are not in these numbers.
| Program | Net reimbursement | CoachCare fees | Net to practice |
|---|---|---|---|
| RPM: devices, data and management | $803,018 | $454,657 | $348,361 |
| PCM: principal care management | $529,082 | $273,078 | $256,004 |
| Implementation, eCW integration and outreach | — | $37,517 | −$37,517 |
| 24-month total | $1,332,100 | $765,252 | $566,848 |
| Enrollment outreach, care management and device logistics are CoachCare's expense: embedded in the fee, never a separate charge to the practice and never deducted from its margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 40.5%, Year 2 43.6%).
Year 1 is $180,306 net to the practice on $444,715 of net reimbursement; Year 2 is $386,542 on $887,384. Month 1 is −$5,495 as the one-time setup lands ahead of the ramp; monthly net is positive from month 2 onward.
Recurring professional-fee volume over 24 months, generated inside eClinicalWorks.
Blood pressure, heart rate and weight, a continuous picture of the panel between quarterly visits, triaged before a physician sees any of it.
About $896K in acute-care cost that never gets spent, at $15,000 per admission. Under any future total-cost kidney arrangement, that is the number scored.
About 12,868 care-team hours of monitoring, outreach and documentation carried by the service line, not by the practice's staff.
The constraint here is the eligibility definition, not outreach capacity. Remote monitoring fills its pool in month 9 and principal care management in month 21; after that the census holds and the monthly economics flatten. Widen the eligible cohort, or confirm a larger one from the chart, and the forecast moves. Add enrollment capacity and the same ceiling is reached sooner.
| Program | Enrollment ceiling | How it is defined | Month 24 |
|---|---|---|---|
| RPM | 460 | 1,750 in scope × 75% eligible × 35% acceptance | 460 |
| PCM | 446 | 1,750 in scope × 85% eligible × 30% acceptance | 446 |
| At month 24 | — | Active program enrollments = 593 unique patients | 906 |
Eligibility is set for a nephrology Medicare cohort. Every point of eligibility or acceptance the practice's own chart data supports beyond these raises the ceiling, and the forecast, directly. Year 1 lands at 537 unique patients.
| Enrollment staffing | 24-mo net reimbursement | Net to practice | Unique, M24 |
|---|---|---|---|
| Practice referrals only, no on-site specialist | $883,518 | $364,568 | 521 |
| One CoachCare-funded on-site specialist (this forecast) | $1,332,100 | $566,848 | 593 |
| Two specialists | $1,519,776 | $653,056 | 593 |
| Three specialists | $1,606,530 | $692,646 | 593 |
The month-24 census is the same at one, two and three specialists, because the ceilings bind. The revenue still moves, because the same ceiling is reached months sooner and the extra patient-months are real. Without a funded specialist the practice's own referral flow reaches less than half the forecast.
CoachCare operates as the service line's engine while the practice's nephrologists govern protocols and every clinical decision. Full-service delivery means launch needs no new hires, the eClinicalWorks integration is native, and the transitional-care path produces cash before any device ships.
Agree the escalation routing and who receives non-critical alerts. Pull the stage 3b–5, resistant-hypertension and post-discharge cohorts out of eClinicalWorks and confirm the enrollable list against the panel estimate in this analysis.
Turn on the eCW integration, configure the time-capture and code mapping, and run a claims test on the transitional care management path first.
The funded specialist starts at the St. Mary and Ambassador Caffery offices, with New Iberia scheduled, working from the confirmed cohort list. Devices ship to enrolled patients. First readings arrive and the escalation engine goes live with the practice watching every route.
The census builds toward the ceilings in the analysis. Blood-pressure control, volume management and post-discharge touches accumulate as retrievable reports, which is what any kidney model, current or next, will ask to see.
The service line on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs on the CoachCare platform.
Programs implemented and operating in market.
Care plan coding and billing that has produced over 5 million claims. The billing path is not an afterthought here; it is the part most remote-care programs get wrong.
Over 100 million vitals recorded and 4 million+ care actions enabled.
CMS has proposed cutting the remote-monitoring device-supply codes for CY2027. The proposal is narrower than the headline. Here is what it does to the forecast on this page, priced at the Louisiana locality amounts the forecast itself uses rather than national averages.
The proposal reaches the remote-monitoring family only. Principal care management is not in it, and on this forecast PCM carries $529,082 of the $1,332,100 in 24-month net reimbursement. Its own amounts move by well under a point through the conversion factor, so $3,292 of the $77,097 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 practice owns the clinical program and the billing. Whichever way the final rule lands, the program does not have to be rebuilt.
CMS's ACCESS Model points at the destination: remote care paid as a risk-based per-member-per-month amount, with half of each payment withheld and reconciled against outcome attainment. A practice that already runs its dialysis patients on a monthly protocol has the reporting habits such a payment rewards.
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 red can be compared directly across them.
24-month net reimbursement, CY2026 final versus CY2027 proposed, every code repriced at Novitas Louisiana locality 99 amounts, non-facility, on this forecast's own billing mix. Enrollment, acceptance and mix held constant. This is the rate change alone.
National non-facility amounts from the proposed rule's Addendum B, so the movement can be read without a locality in the way. The repricing above uses Louisiana locality 99 amounts; the two bases do not reconcile to the dollar, by design.
| 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: principal care management | ||||
| 99426 | Principal care management, first 30 minutes (clinical staff) | $67.80 | $67.00 | −1.2% |
| 99427 | Principal care management, each additional 30 minutes | $54.11 | $54.52 | +0.8% |
| 99424 | Principal care management, first 30 minutes (physician) | $87.51 | $84.40 | −3.6% |
| 99425 | Principal care management, each additional 30 minutes (physician) | $61.46 | $59.11 | −3.8% |
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 CY2028.
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.
Six reasons this partnership fits Acadiana Renal Physicians specifically, not remote care in general.
CoachCare integrates bi-directionally with eClinicalWorks: eligibility flags and orders leave the EHR, and discrete vitals, care documentation and claim-ready charges come back into it. One chart for the nephrologists, one workflow for the billing team, and no second system to learn to start.
Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation sit on CoachCare's payroll. The practice inherits a running program the month it turns on, at a 42.6% practice margin, with no hiring cycle. On-site enrollment is our expense — telephonic outreach converts about 8%, so we staff the clinic instead.
Your nephrologists set the protocols, sign the care plans and make every clinical decision, and claims go out under the group's own entity and NPIs. CoachCare supplies the staff, devices, platform and billing preparation under that governance — the operating model an independent group keeps control of.
About 42% of Medicare beneficiaries in Lafayette Parish are in Medicare Advantage, and 32% of the practice's panel is dual-eligible. MA plans pay these code families at the Medicare rate as a floor, with terms set contract by contract, and dual-eligible patients owe no coinsurance, so enrollment leads with the care. The forecast is priced at the Medicare rate throughout.
Chronic kidney disease and resistant hypertension carry the longitudinal monitoring, dialysis starts and hospital stays open transitional care management windows, and the whole panel documents monthly under principal care management. A risk score of 3.11 across the practice is exactly the population these codes are written for. One remote care service line covers all of it.
Fees are per active patient per month; there is no capital outlay and no payroll ramp. Because the forecast is set by enrollment pace, throughput is the lever. If the census does not build, CoachCare does not get paid, and the forecast, Disclosures and workbook behind this page are yours to keep either way.