The between-visit work your cardiologists already direct — weight and blood-pressure tracking, symptom checks, medication titration, the follow-up after a hospital stay — is what Medicare reimburses under Remote Patient Monitoring and Principal Care Management. Today none of it is billed, and no remote-care vendor sits in the way. This page models it as an owned, margin-positive service line across your three El Paso sites.
A cardiology panel generates a steady stream of between-visit management — reviewing home weights and pressures, catching a diuretic problem before it becomes an admission, titrating guideline-directed therapy, following a patient through the 30 days after a hospital stay. Remote Patient Monitoring and Principal Care Management were written to reimburse exactly that. At El Paso Cardiology the work happens the way it does at most independent groups — informally, by phone, uncounted — and there is no third-party remote-monitoring vendor in the building. That is the opening: a service line the practice owns, on codes that already pay.
A cath-lab and device practice already runs post-procedure follow-up, arrhythmia and device checks, and heart-failure management. The instinct to watch patients between visits is there. What is missing is the reimbursed modality and the entity that submits the claim.
El Paso County runs about 72% Medicare Advantage, so roughly a quarter of the Medicare panel is traditional fee-for-service — and that is precisely where RPM and PCM bill per claim, month after month. The MA majority is real volume too; those terms are set contract by contract.
Standing the protocol up as a practice-billed line turns uncompensated work into recurring revenue, and puts the readmission and titration levers inside the group that manages the patient. Same patients, same protocol, a modality that pays.
El Paso Cardiology Associates is an independent, physician-owned group: roughly a dozen cardiologists across a west-side clinic, an east-side clinic and a cath lab, with interventional, imaging and peripheral-vascular depth. The remote-care line docks onto that base without adding practice headcount.
A professional association led by its own physicians, with no health-system parent. Decisions on a new service line are made in the practice, not at a corporate office — the shortest path from yes to launch.
Interventional cardiology and a cath lab, echocardiography and nuclear imaging, peripheral vascular disease and amputation-prevention work, across three El Paso sites including a recently opened west-side clinic.
No physiologic Remote Patient Monitoring program and no Principal Care Management program is in evidence, and no third-party remote-care vendor appears anywhere. A clean build, not a migration.
El Paso County sits near the top of the country for Medicare Advantage. That shapes the mix, and it makes the traditional fee-for-service slice — where these codes pay per claim — worth capturing deliberately rather than by accident.
The case for building this year does not rest on a policy deadline. It pays for itself under fee-for-service now, and it is the same operating chassis any future model would require — so the timing is upside either way.
El Paso sits outside the selected geographies for CMS's mandatory specialty and episode models — no downside adjustment is coming at this market. That is a clean position: build the service line for the margin, and be model-ready if the selection maps ever change, with nothing at risk if they don't.
RPM and PCM bill every eligible patient, every month, on documented management the practice already directs. It is revenue that does not depend on the procedure schedule or a referral surge — the steadiest line a cardiology group can add.
Continuous physiologic trends, documented monthly management and structured post-discharge coordination are what every value arrangement — and every hospital partner's readmission scorecard — is graded on. Running the service line produces that record as a by-product.
The wedge is simple: this line is profitable on day-one economics, and it is the chassis for whatever comes next. Build it now for the fee-for-service margin, and any future shift toward risk opens with an enrolled panel and a coordination record instead of a blank page.
A named service line with its own owner, P&L and scorecard, run by the practice's cardiologists and advanced practice providers, following the Medicare patient between visits inside the chart the practice already uses. The sequence starts at the hospital door.
| Service | Codes | 2026 Rate (TX 04412-99) | Cardiovascular Use |
|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | Not modeled — upside | The discharge handoff; excluded from every figure on this page |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | $20.57 · $49.43 · $49.43 | 99445 makes 2–15-day post-discharge monitoring windows billable |
| RPM treatment management | 99457 · 99458 · 99470 (new) | $50.11 · $40.28 · $25.22 | Monthly review, diuretic and guideline-directed therapy titration, escalation |
| Principal Care Management | 99426 · 99427 | $65.94 · $52.48 | The single high-risk condition — heart failure or coronary disease, cardiology-native |
Rates auto-resolved from the CY2026 Physician Fee Schedule for MAC carrier 04412, locality 99 (Texas; zip 79902).
The service line runs inside the chart the practice already uses. CoachCare integrates with eClinicalWorks so enrollment, discrete vitals, care-management documentation and claim-ready charges flow between the platform and the EHR — clinicians and billers never leave their workflow, and nobody logs into a second system to do the work.
Weights, blood pressures and oximetry land in the flowsheet as structured data the practice can trend, filter and report on — not a stack of PDFs to open one at a time.
Care summaries, time logs and compliance documentation post back into the chart and the billing workqueue, so the codes are supported by the record without a parallel paper trail.
Clinicians and staff stay in eClinicalWorks. Enrollment status is visible in the chart in real time, and patients keep the healow experience they already use.
Monitoring is only as good as what happens when a reading is bad. This is the same weight-and-symptom work made billable, documented and escalation-safe — a service line the practice owns and controls. It is the operating model behind the roughly 187 hospitalizations the Value Analysis models as avoided, and the documentation trail a payer or a hospital partner is graded on.
Remote Patient Monitoring and Principal Care Management readings route through one decision path — one standard, not per-nurse judgment. Noise is filtered at the source; genuine risk moves immediately.
If an active, emergent symptom surfaces during any outreach, the care team calls 911 with the patient still on the line — it does not wait for a callback or a routing decision.
If the patient refuses, the care team loops in the clinic; if the clinic is unavailable, CoachCare activates 911 itself. This urgent/emergent policy supersedes any local escalation preference — there is no configuration in which an active emergency waits. A symptom present recently but not active at the time of contact follows the practice's stated preference instead.
Physicians are not paged for what does not need them. Each event is sorted by severity and sent to exactly one destination.
Active emergent findings bypass routing entirely — the emergency pathway runs, with the patient on the line and the practice notified.
Out-of-range readings and confirmed trends route to a defined practice team member under the practice's protocols — not a general in-box, a specific owner.
Readings that self-resolve or return to range are recorded for the chart and trend history without interrupting anyone.
An emergency-room visit or hospitalization in the last 60 days triggers a structured cadence over the first two weeks — the window where heart-failure readmissions are made or prevented. Every touch is documented and escalates on the same logic.
A 24-month forecast for the cardiology remote care service line. The panel: roughly 9,700 Medicare patients across the practice's three El Paso sites, sized from CMS billing data and grossed for the county's ~72% Medicare Advantage share, with 12 referring physicians, one CoachCare-funded on-site enrollment specialist, telephonic enrollment, MAC-locality rates for TX 04412-99 (zip 79902) and native eClinicalWorks integration. Avoided-admission savings are not in these numbers — they are upside on top.
| Program (24-Month) | Net Reimbursement | CoachCare Fees | Practice Margin |
|---|---|---|---|
| RPM — remote physiologic monitoring | $2,644,287 | $1,477,002 | $1,167,285 |
| PCM — principal care management | $962,000 | $500,130 | $461,870 |
| Implementation, integration & ancillary | — | $93,868 | −$93,868 |
| 24-month total | $3,606,287 | $2,071,000 | $1,535,287 |
| By Year | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Net reimbursement | $884,680 | $2,721,607 | $3,606,287 |
| CoachCare fees | $502,257 | $1,568,743 | $2,071,000 |
| Net to practice (after fees) | $369,038 | $1,166,249 | $1,535,287 |
| Practice margin (% of net reimbursement) | 41.7% | 42.9% | 42.6% |
| Delivered full-service — telephonic enrollment, devices, 24/7 monitoring and billing handled by CoachCare. The on-site enrollment specialist is staffed at CoachCare's expense: embedded value, never a deduction from the practice's net. | |||
The full model is available as a companion Value Analysis workbook.
The census line plots active program enrollments. Unique patients are derived from that census — RPM census plus 30% of the PCM census — and are always the smaller number. At the modeled scenario the explorer reproduces the workbook run: Month-24 census of 2,266 RPM · 880 PCM = 3,147 enrollments (2,530 unique patients) and $3,606,287 of 24-month net reimbursement.
Reimbursement is the reason the service line sustains itself. These are the reasons it matters to the heart-failure and coronary population — and to the practice's own capacity.
Recurring, subscription-like professional-fee volume across 24 months — revenue that does not depend on procedure schedules or referral surges.
A continuous picture of weight, blood pressure and oximetry trends between visits — the earliest available signal of heart-failure decompensation.
≈ $2.8M in avoided acute cost at $15K per admission — a benefit to the patient, the hospital partners who carry the readmission penalties, and any future risk arrangement.
≈ 15 FTE-equivalent of monitoring, outreach and documentation performed by CoachCare — work the practice does not hire for.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring and billing-ready documentation — while the practice's cardiologists and advanced practice providers govern protocols and every clinical decision. Full-service delivery means launch requires no new practice headcount; the staffing model formalizes as census grows.
Named owner, P&L and scorecard. Confirm the eClinicalWorks interface scope, configure the integration and billing, set the PCM attribution policy against the named principal cardiac condition for each patient, and sign off the heart-failure, post-discharge and arrhythmia pathways.
Start where the clinical stakes are highest: patients discharged with heart failure. TCM at discharge, then RPM plus Principal Care Management, with protocolized diuretic and guideline-directed therapy titration and telephonic enrollment.
Extend RPM to the coronary, device-follow-up, CKD and hypertension populations; extend Principal Care Management across the broader cardiac panel; add advanced-practice providers to the referring roster. Monthly scorecard to service-line governance.
Harden the titration and documentation production process, tune the second-enrollment-specialist decision against the enrollment curve, and carry a coordination record that any future value arrangement would require — built, not planned.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for more than 500,000 patients.
Providers running remote care programs day to day.
Successful program implementations.
Care-plan coding and billing behind more than 5 million claims.
Over 100 million vitals recorded and more than 4 million care actions enabled.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how this service line absorbs it — priced at El Paso's own MAC locality, not national averages.
CMS's remote-monitoring proposals sit in one code family: RPM. PCM and TCM are not part of them. That lands directly on this forecast — PCM carries $962,000 of the modeled $3,606,287 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the economics hold wherever the rule settles. One unbundles the program into SaaS platform, device logistics, and program enablement, priced as components. Another runs the staffing itself, an MSO-style arrangement in which the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is one of its clinical tracks. What earns under that structure — controlled pressures, titrated therapy, decompensations caught early — is what this service line is built to produce.
This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality (TX 04412-99) rather than national averages. Same enrollment, same phasing plan — only the rates move.
Both bars run on the same dollar scale, so the pink cut slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the care-management revenue RPM alone does not include.
Repriced at this locality's own geographic adjusters (work 1.000 / PE 0.949 / MP 0.903). The RPM reductions fall almost entirely on the practice-expense component, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be about −9.4% on RPM. Of the $253,884, RPM accounts for $248,746 and the care-management arm for $5,138.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99426–99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those families moves within about 4% either way, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.
Six reasons this partnership fits El Paso Cardiology 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. No second system for clinicians, no re-keying for the billing team, and no reason to change platforms to start.
Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. The practice inherits a running program the month it turns on, at a 42.6% margin, with no hiring cycle. The on-site enrollment specialist is our expense, not a deduction from your net.
There is no existing remote-care vendor to rip out and no legacy contract to buy out. A program built on top of a working cath-lab practice is the fastest kind to stand up and the cheapest to run — you are adding a line, not migrating one.
In a county that runs about 72% Medicare Advantage, the fee-for-service quarter is where RPM and PCM bill per claim, month after month — and the MA majority is real volume whose care-management terms we handle contract by contract. That mix is worked deliberately here, not left to chance.
Your cardiologists set the protocols, sign the care plans and make every clinical decision, and claims go out under the practice's own entity. CoachCare supplies the staff, devices, platform and billing preparation under that governance — the operating model an independent group keeps control of.
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 — a second on-site specialist is ours to add. 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.