Frequently asked questions

In our Hospital Program, CareAtlas serves as the provider of record through our affiliated professional corporation. We bill Medicare directly. The hospital refers patients and benefits from improved outcomes — no upfront investment, no new hires required, and no implementation fees.

No. Every patient is assigned a dedicated, named care navigator — a real person who calls them regularly, learns their history, and builds a genuine relationship over time. Our navigators are licensed professionals, not scripted operators. That human touch is why 73% of our enrolled RPM patients submit readings 8+ days per month — and fewer than 1% of activated patients voluntarily discontinue.

Most RPM programs fail on enrollment and engagement, not technology. Devices sit unused. Patients disengage after 30 days. Staff abandon the program under workload pressure. Our model is different because CareAtlas handles all patient outreach, enrollment, engagement, and billing — completely separate from your staff. Our devices are senior-friendly: cellular-enabled, single-button, no smartphone required.

HealthQuilt integrates with athenahealth (embedded experience in pilot) and Canvas. We're designed for interoperability, not EHR replacement. In many cases, we operate alongside your existing systems and push clinical summaries back into your documentation.

No. HealthQuilt is a care-coordination platform designed to operate alongside your EHR — pulling chart context on ingest, pushing structured clinical summaries back on cadence. Your physicians continue to chart in the EHR they already use. No new login for your clinical staff.

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AI drafts — humans decide. HealthQuilt's AI agents prepare navigators before calls, draft clinical notes during and after, triage incoming RPM readings, and rank care gaps. Every clinical judgment — a new diagnosis, a medication change, a care-plan approval, an escalation — is made by a licensed human, and every AI-generated artifact is reviewed and signed by a clinician before it enters the patient record or the bill.

HIPAA-compliant from the ground up. BAAs with every integration partner and sub-processor. Every patient-record access is logged. Role-based access control across navigators, clinicians, billing staff, and partner users. SOC 2 documentation and compliance posture available during diligence.

Target go-live is 60 days. CareAtlas handles device procurement (where applicable), patient enrollment workflow, navigator training, EHR integration setup, and billing configuration. Your team's involvement is typically a kickoff meeting, a clinical point of contact, and access to referral workflows.

Yes. CareAtlas offers three models. CareAtlas Complete provides navigators and clinicians end-to-end. CareAtlas Extend augments your existing team with overflow staffing and the platform. CareAtlas Connect is platform-only — you bring the team, HealthQuilt runs the coordination. Same platform across all three.

Because running CCM well is hard. The billing is time-based and requires structured capture of every qualifying minute and every required element. The monthly cadence collapses when it competes with clinical staff's in-office workload. The documentation is exacting. Most practices either never launch the program or launch it and see enrollment plateau. CareAtlas's model is different: we run the cadence, we capture the elements, we handle the billing — completely separate from your clinical staff's queue.

The 2026 Medicare Physician Fee Schedule finalized approximately a 10% reimbursement increase across the CCM code set — 99490 at ~$66 PMPM, 99439 at ~$50 per additional 20 minutes, 99487 at ~$144 PMPM for complex CCM. No new CCM codes were introduced. The program got more valuable; the operational difficulty that kept enrollment at 4% did not change. CareAtlas is the operational layer.

Structurally, as it happens. Every navigator touch logs start time, end time, participants, elements covered, and clinical outcome. HealthQuilt rolls those logs into CCM time records automatically — so the 20-minute threshold for 99490, and the additional increments for 99439, are documented, not reconstructed.

APCM is the baseline program for every CareAtlas patient — comprehensive primary care management billed monthly across three risk tiers. CCM covers patients whose clinical coordination burden exceeds what APCM's funding envelope covers. CareAtlas routes the escalation automatically so the patient gets the right level of care and the practice bills the right program.

Yes. FQHCs and RHCs that bill G0511 for care management services receive the same operational support from CareAtlas as a non-FQHC practice billing 99490 / 99439 / 99487 / 99489. CareAtlas captures the time and elements required under G0511's bundled structure and prepares claim-ready documentation.

CareAtlas Complete is a partnership model. CareAtlas serves as provider of record through our affiliated professional corporation, bills Medicare directly for RPM, CCM, TCM, and APCM services, and aligns economics with the referring hospital through a partnership structure. No upfront investment. No implementation fees. No new FTEs required on your side.

Our affiliated professional corporation holds the provider enrollment with Medicare. CareAtlas's licensed clinicians provide the oversight required by each program. The hospital refers eligible patients; CareAtlas enrolls them; CareAtlas's clinicians sign the required care plans and documentation. Your hospital's clinicians continue to see the patients for face-to-face visits as usual. Insights from every navigator touch flow back into your EHR so the discharging clinicians and PCPs see what's happening.

Our published cohort (145 patients; 89% age 65+; 38% COPD; 24% CHF — October 2025) showed a 14.8% 30-day readmission rate against the 19% CMS benchmark — a 23% relative reduction — with under 1% voluntary discontinuation and 73% RPM device adherence. Results vary by population; we model the projected impact for your population during a working diligence session.

Yes — rural is where the model has been most rigorously proven. Our devices are cellular-connected, so patient broadband is not required. Our navigators are licensed, so licensure coverage across rural states is solved operationally. HealthQuilt integrates directly with athenahealth (embedded experience in pilot) and connects to other EHRs via industry-standard integration layers — so the EHR the small hospital already runs is the EHR CareAtlas runs alongside.

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Three reasons, all operational. Devices sit unused because setup requires WiFi or a smartphone. Patients disengage after 30 days because no one calls them. Staff abandon the program because the device-alert stream overwhelms the clinical workflow. CareAtlas built the operating model to eliminate all three: cellular devices with no setup, a named navigator calling every enrolled patient on cadence, and AI-assisted triage that routes only clinically meaningful signals to a clinician.

The 2026 Medicare Physician Fee Schedule finalized two new RPM codes that materially expand which patients can participate in a billable program. 99445 covers the 2–15-day transmission window — so patients who engage but don't hit the old 16-day threshold are now both clinically monitored and billable. 99470 covers 10–19 minutes of monthly treatment management — below the previous 20-minute threshold — requiring at least one real-time interactive communication. The two additions bring RPM inside reach for stable chronic-condition panels whose monthly engagement footprint was previously sub-billable.

Cellular-connected blood pressure cuffs, glucose monitors, pulse oximeters, scales, and weight monitors. Pre-provisioned — the patient opens the box, presses a single button, and the reading flows back automatically. No WiFi, no smartphone, no Bluetooth pairing, no app to install.

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In our 145-patient RPM/CCM cohort (89% age 65+, 38% COPD, 24% CHF — a high-risk Medicare population), 73% of enrolled patients submitted readings 8+ days per month. Voluntary discontinuation was under 1%. Results as of October 2025.

RPM is billable alongside both APCM and CCM for the same patient, in the same month. The navigator who runs the RPM cadence is typically the same navigator who runs the APCM or CCM touch — so the daily device signal informs the monthly care conversation. Patients don't experience "four programs." They experience one navigator, one relationship, one care team.

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The readmission-reduction claim is based on a 145-patient RPM/CCM cohort that achieved a 14.8% readmission rate against a 19% CMS benchmark—a 23% relative reduction. That cohort's composition (89% age 65+, 38% COPD, 24% CHF) is intentionally disclosed so the benchmark comparison is honest. RPM is one of the major operational levers driving the reduction; TCM and CCM complete the model.

Operationally, not clinically. The 2-business-day outreach call is the first thing that slips when it competes with in-office clinical workload. Without that call documented structurally, the face-to-face follow-up visit — even if it happens inside the required window — doesn't become a billable TCM episode. The clinical work was done; the claim wasn't. CareAtlas runs the outreach as a dedicated, separately staffed workflow so the window holds.

Directly. 30-day readmissions are concentrated in the post-discharge window TCM covers. Medicare spends ~$17.5B annually on readmissions, roughly $12B of it potentially preventable. TCM's structured outreach, med-rec, and follow-up scheduling are the mechanics by which that prevention actually happens. In our 145-patient RPM/CCM cohort, the readmission rate was 14.8% against the 19% CMS benchmark — a 23% relative reduction.

In the hospital model, CareAtlas bills Medicare directly through our affiliated professional corporation — the hospital refers, CareAtlas runs the transition, and the claim is captured under the affiliated PC's NPI. In the practice model, the practice bills TCM; CareAtlas delivers the operational workflow and exports a clean claim into the practice's RCM.

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The patient transitions into an ongoing CareAtlas program — typically APCM (the baseline) with CCM or RPM layered in based on clinical need. The navigator who built rapport during the 30-day TCM episode continues as the patient's navigator. No handoff, no drop-off.

No. CareAtlas receives the discharge notification through the channel the partner already uses (CarePort, direct EHR integration, fax, or CSV), runs the TCM workflow inside HealthQuilt, and delivers a structured TCM summary to the PCP — into the EHR where supported, or via secure document exchange — before the follow-up visit. No new software for your staff.

APCM reimburses for comprehensive primary care management on a monthly basis across three risk tiers — G0556, G0557, and G0558. Qualifying elements include an initial comprehensive care plan, ongoing patient access, structured coordination activities, and — unlike CCM — no time-tracking threshold. CareAtlas captures every required element structurally as the work happens, so the claim is clean.

Yes. APCM and RPM are billable concurrently for patients who benefit from both. CareAtlas enrolls and bills them together where clinically appropriate — maximizing care delivered and revenue captured per patient.

For many patients, yes — APCM's cleaner billing structure and broader scope make it the better fit. For patients whose monthly coordination time clearly exceeds what APCM covers, CCM remains the right program. CareAtlas routes the clinical escalation so patients get the care level their condition requires and the program billed matches the work.

The PCP stays provider of record. CareAtlas drafts, captures, and bills the qualifying work; the PCP reviews and signs the care plan; insights from every navigator touch flow back into the PCP's EHR. The physician's visit workflow is unchanged.

Our public target is 60 days from signature to first enrolled patient. Enrollment continues after go-live, so revenue builds monthly as more eligible patients on your panel come onboard.

Yes. In CareAtlas Complete for practices and in CareAtlas Extend, your practice is the provider of record. Your physician signs the care plans and the required documentation. CareAtlas operates as a clinical extension of your practice — the navigators deliver the monthly touches, the platform captures the qualifying elements, and the claims export cleanly into your existing RCM or are billed through CareAtlas under our affiliated professional corporation in the hospital model.

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Each enrolled patient generates a predictable monthly reimbursement based on the program(s) they're enrolled in. APCM is approximately $16, $54, or $117 per patient per month depending on risk tier. RPM adds device-supply and clinical-monitoring codes on top — with the new 2026 codes (99445 for 2–15 day transmission and 99470 for 10–19 minutes of monthly clinical time) extending RPM's billable reach to patients the old thresholds excluded. CCM, with its approximately 10% reimbursement increase under the 2026 PFS, and TCM add further billable work where clinically indicated. Our blended expected range for a well-run practice is $50–$120 PMPM in gross new Medicare revenue per enrolled patient. CareAtlas's platform fee starts at about $10 PMPM — a fraction of that — so your practice keeps the majority as margin. Revenue varies by program mix, volume, and payer. Not a guarantee of income.

No. Every patient is assigned a dedicated, named care navigator — a licensed professional who calls them on cadence, learns their history, and builds a relationship over time. Our navigators are not scripted operators. That's why 73% of our enrolled RPM patients submit readings 8+ days per month — and fewer than 1% voluntarily discontinue.

HealthQuilt connects through standards-based HL7 FHIR — the interoperability standard every certified EHR is required to support — so CareAtlas runs alongside the EHR your practice already uses (Epic, Oracle Health, athenahealth and Canvas without an IT project. We're live today with athenahealth.

Our public target is 60 days from signature to first enrolled patient. Revenue builds monthly as the enrolled panel grows.

Yes — because he doesn't have to figure much out. The cellular device ships pre-paired with a one-page guide and a single button. Before the first reading, a named navigator calls to walk through it on the phone. No WiFi. No Bluetooth pairing. No smartphone. If a patient can press one button, they can do this.

The navigator leaves a voicemail and tries again. The cadence is built around the patient, not the staff — if daytime isn't working, we shift. The 4+ monthly touches are a cohort average because we make the schedule fit the patient, not the other way around.

CareAtlas navigators include Spanish-speaking staff, and we provide qualified interpreter services at no cost for any other language. Every patient is supported in the language they're most comfortable with.

Navigators slow down, repeat, and confirm. For patients with a caregiver present, the caregiver can be added to the call with the patient's consent. For patients who prefer written communication, we can shift a portion of the monthly touches to SMS or mail.

They can. Under 1% of activated patients voluntarily discontinue — but those who do get an exit call, their device returned with a pre-paid label, and no awkwardness. The program is opt-in every month.

Yes. FQHCs and RHCs that bill G0511 for care-management services receive the same operational delivery from CareAtlas as non-FQHC practices billing under 99490 / 99439 / 99487 / 99489. CareAtlas captures the time and elements required under G0511's bundled structure and prepares claim-ready documentation. We understand the G0511 nuance and the CMS guidance that sits around it.

Yes. Our devices are cellular-connected and pre-provisioned. The patient opens the box, presses a single button, and the reading flows back automatically. No WiFi, no smartphone, no pairing, no app. This is a deliberate design choice — the populations most FQHCs and RHCs serve cannot depend on home broadband.

Yes — in fact APCM's Level 3 tier ($117 PMPM) was specifically designed for QMB and dual-eligible populations. The reimbursement reflects the coordination burden these patients carry. APCM is generally the most revenue-aligned Medicare program for FQHCs whose panels lean toward QMB and dual-eligible.

We don't touch 340B procurement or UDS reporting directly — those remain your center's responsibility. We provide structured clinical summaries and care-management documentation that flow back into your EHR, so the work done under CareAtlas's programs is fully visible for any operational and reporting process your center already runs.

In CareAtlas Connect, HealthQuilt deploys across your contracted PCPs and their care teams — same platform, same workflows, same documentation standards. In CareAtlas Extend, CareAtlas's navigators operate across the network to supplement contracted PCP staff. In either model, the coordination layer is consistent regardless of which PCP a patient is attributed to. Each contracted PCP's existing EHR and RCM stay untouched.

Yes — specifically, the measures that depend on annual-or-more-frequent care-management activity (blood pressure control, diabetes control, medication adherence, annual wellness visit, transitions-of-care documentation, follow-up after hospital stay). CareAtlas runs the cadence and captures the qualifying activity structurally, so the measure attestation is documented and defensible.

Yes — that's the point. CareAtlas's programs bill fee-for-service today, so your contracted PCPs capture per-patient Medicare revenue alongside the population-health impact. The coordination, touch, and outcome data we capture under FFS becomes the denominator data for your VBC contracts as they mature. We're designed for the transition, not against it.

CareAtlas operates on the attribution lists your VBO already maintains — we do not reassign patients or alter attribution logic. Every CareAtlas touch, care plan, and clinical summary is delivered back to the attributed PCP — into the EHR where supported, or via secure document exchange — so documentation and risk-adjustment capture happens inside their existing workflow. Care-management activity under CareAtlas does not alter the attribution fence; it strengthens what's inside it.

Target go-live is 60 days from signature to first enrolled patient per contracted PCP that deploys. At the VBO level, deployment is phased — starting with a subset of willing contracted providers and expanding outward as proof points accumulate.

The calculator returns steady-state annual revenue — what the panel earns once enrollment is fully ramped. Our public commitment is 60 days from signature to first enrolled patient, and enrollment then ramps over the first two quarters. Year-one actual revenue is typically a fraction of the steady-state figure, and Year 2 onward looks much closer to it.

CareAtlas serves as provider of record through the affiliated professional corporation and bills Medicare directly under the PC's NPI. CareAtlas shares revenue with the hospital partner under a partnership-based model — no upfront investment from the hospital, no new hires required. Specific economics are partnership-dependent and discussed during diligence.

Your practice stays provider of record. HealthQuilt exports clean, scrubbed claims into your existing RCM and your practice retains the full Medicare reimbursement. CareAtlas charges a per-enrolled-patient service fee — meaningfully smaller than the per-patient Medicare revenue you collect, so per-patient net economics stay strongly positive. Specific pricing is discussed during diligence.

The calculator's outputs are approximate. Your Medicare Administrative Contractor publishes locality-specific rates that may differ by approximately ±15% from the national averages used here. During a demo, we can model your actual locality on your actual panel.

The outputs are gross billable revenue. CareAtlas's structured-capture workflow — every required element captured during the work, not reconstructed afterward — produces materially cleaner claims than retroactive time-attestation workflows. Realized revenue tends to track close to billable revenue. Exact denials performance is partnership-specific and reviewed during quarterly business reviews.

60 days. That covers implementation, device procurement (where applicable), patient enrollment workflow setup, navigator training, EHR integration, and billing configuration.

The version on this page uses national averages for APCM tier distribution (Level 1 / Level 2 / Level 3). During a demo, we model your actual panel — including the QMB / dual-eligible share that drives Level 3 enrollment — for a much tighter estimate. Community health centers in particular tend to have a higher Level 3 share than the national average.