Four steps. You approve each one.
We audit your panel
You pull four counts from your EHR. We return one page: who qualifies, at which tier, and what it is worth.
Your team enrolls patients
Consent happens in the visit, from people your patients already trust. Once per patient, not every month.
We run the monthly service
A check-in with every enrolled patient. Medication gaps and symptoms are flagged, and anything clinical goes to a person.
Your physician signs, you bill
Routine months are signed together in minutes. Flagged ones are reviewed one by one. The claim goes out under your tax ID.
Three numbers, one order of magnitude.
The audit replaces these guesses with your real counts.
| Code | Patient | Per month |
|---|---|---|
| G0558 | Two or more chronic conditions, qualified Medicare beneficiary | $117.24 |
| G0557 | Two or more chronic conditions | $53.78 |
| G0556 | One or no chronic conditions | $16.37 |
2026 national non-facility allowed amounts. Medicare pays 80% and the other 20% is coinsurance. Rates vary by locality. Behavioral health add-ons (G0568–G0570) can be billed alongside. The estimate counts only what you are likely to collect.
Your panel
Change any number.
You sign the claim. You should know what we do.
- Work under a signed BAA.Encrypted in transit and at rest, access logged, minimum necessary.
- Keep a person in the loop.Anything clinical is reviewed by a human before it reaches you.
- Write it to the chart.Contacts, flags and your team's decisions, ready to hand to an auditor.
- Skip months we could not deliver.If a patient could not be reached, that month is not billed.
- Give medical advice or make clinical decisions.We escalate. Your practice decides.
- Take a share of your collections.A fixed fee per enrolled patient, charged only for delivered months.
- Let a robot take consent.Your staff ask, in the visit, in their own words.
- Replace a visit.Check-ins surface what needs you sooner. They do not substitute for you.
What practices ask first.
Does this cost my patients anything?
Normal Part B coinsurance applies, about eleven dollars a month at the common tier. Patients who are qualified Medicare beneficiaries owe nothing, and many supplemental plans cover the rest. The audit shows how your panel splits, because that decides whether the program is worth running.
Do you need access to our EHR?
Not for the audit. You enter four counts in our worksheet and no names or records leave your practice. For the ongoing program we read your roster and write notes back to the chart, and only after a Business Associate Agreement is signed.
We already bill chronic care management. Can we switch?
Yes. Those patients need new consent, and the two cannot be billed for the same patient by the same practitioner in the same month. We check for conflicts before every claim.
We are a health center and G0511 is gone. Does this apply to us?
Yes. Since G0511 was retired, health centers bill care management through individual codes or APCM. We also look at community health worker and navigation billing, since health center panels lean toward Medicaid.
What happens if we are audited?
You hand over the record. For each patient: consent with the date and what was said, every monthly contact, the care plan, and your physician's signature with a timestamp.
Start with the audit.
Run it online in two minutes, or fill in the worksheet and send it back. No patient data and no obligation. If the number is too small to bother, we will say so.
nikita@hartley.health · Boston, MA