Your medical billing and revenue cycle management (RCM) company manages the full billing life cycle for physician practices — claim submission, denial management, collections, and increasingly value-added services like quality reporting.

And your commercial model is almost always performance-based: you earn a percentage of client collections, typically 4–8% of total Medicare billings.

Most billing and RCM companies range from small boutique operations serving 5–20 physicians to mid-sized firms managing 50–300+ physicians. And hold both the data and the trust needed to drive MIPS outcomes — but are not currently leveraging either.

Layer 1 — Staffing gap

• Only 1–2 of every 7 coders have real MIPS Quality coding experience.
• MIPS requires CMS measure spec knowledge, G-code logic, and eligible population rules.
• Training is slow and turnover is high — the expertise doesn't stick.

Layer 2 — Cost perception

• MIPS is viewed as overhead, not a revenue opportunity.
• CMS rules change annually — RCM & billing companies see complexity, not upside.
• Most either avoid MIPS entirely, do it minimally, or refer clients out.

Layer 3 — Client leakage

• Clients sent to 3rd-party registries for MIPS create a competing relationship.
• The registry becomes the trusted MIPS expert the physician relies on.
• This creates real churn risk on the billing company's core RCM contract.

Billing companies earn 4–8% of client Medicare collections. A MIPS penalty reduces the fee schedule; a MIPS bonus increases it. That means every MIPS point directly impacts the billing company's own bottom line — automatically, before any MIPS service fees are counted. A practice with a $2M Medicare base and a 10-point MIPS gain generates ~$48K in additional revenue. At 6%, that's $2,880 per practice, per year — compounding across their entire client portfolio.

Model 1 — Our team advises through the billing co.

• Billing co. keeps the client relationship front and center.
• Our team advises on strategy, runs its platform, submits via Certified Registry.
• Billing co. earns a referral or revenue share.
• Lowest lift to start — fastest path to revenue.

Model 2 — MIPS in-house with our team’s tools

• Billing co. licenses our team’s platform + AI suite directly.
• Delivers MIPS services under their own brand to clients.
• Our team provides onboarding, training, and CMS submission via Certified Registry.
• Best long-term model — full margin retained.

Model 3 — Our team trains your coders

• Our team trains your quality coders on AI Suite + measure logic.
• Coders work inside existing workflow using our team’s tools.
• Builds durable in-house MIPS capability over time.
• Ideal for mid-sized firms that want to own MIPS but lack bench depth today.

Model 4 — Revenue share partnership

• Together we share revenue from MIPS consulting, optimization, and CMS submission.
• Structure varies based on who is doing the work.
• Directly aligned incentives — both parties grow when scores improve.
• Works best alongside Model 1 or 2.

Models are not mutually exclusive — most clients start at Model 1 and evolve toward Model 2 over time.

Driver 1 — Code faster, code better

• Decision trees enforce CMS measure logic at the encounter level — no reliance on memory.
• AI handles ambiguous encounters automatically, reducing escalations and rework.
• Queue Manager routes complex cases and tracks completion across the team.
• Result: more encounters per coder-hour, fewer errors, less pre-submission rework.

Driver 2 — Add a billable service line

• MIPS consulting, score optimization, and CMS submission become billable deliverables.
• Our team’s Certified Registry handles CMS submission — no separate registry credential needed.
• Clients who went to 3rd-party registries stay inside the billing company's relationship.
• Result: new, recurring, high-margin revenue on top of existing RCM billings.

Driver 3 — Revenue multiplier

• Earn 4–8% of client collections — tied directly to the fee schedule.
• Higher MIPS score → higher Medicare fee schedule →higher physician billings →automatic revenue gain.
• Our team’s platform makes this math visible: penalty floor, current trajectory, target, max reward.
• No behavior change required —the revenue gain is automatic when scores improve.

Our team’s financial intelligence + certified registry platform translates MIPS scores into real dollar outcomes —penalty, trajectory, target, and max reward — in a single view. It handles all CMS eligibility queries and submission.

Our team’s AI coding workbench + AI inference engine features 28+ decision trees built from CMS measure specs. AI flags ambiguous encounters before submission. Audit workbench creates a defensible correction trail. Zero installation — single HTML file.

Our team makes the dollar math visible. The AI suite makes the scores accurate.

"MIPS isn't worth our time — the penalties are small."

The math compounds quickly. A $2M Medicare base with the max -9% penalty = $180K in lost revenue. At 6%, that's $10,800 per practice. Multiply across 50 physicians.

"We don't have coders with MIPS experience."

That's exactly the gap our AI Suite solves. Decision trees encode CMS logic so general billing coders can produce accurate MIPS coding without MIPS expertise. The tool is the expertise.

"Our clients already use a registry."

That's client leakage you're funding. Billing companies don't need a certified registry credential to submit to CMS — just the right knowledge and tools.

"This sounds complicated to set up."

Our team ingests your existing billing data. AI suite integrates directly into it. Most clients are operational within a few days of onboarding.

"We'd need to train our whole team."

Our team provides training as part of onboarding. We can train a small MIPS-specialist team — and the decision trees do most of the heavy lifting anyway.

Strong fit

• Manages 30+ physician clients or providers.
• Currently does basic MIPS reporting but no quality coding workflow.
• Earns a percentage of client collections (not flat-fee only).
• Has lost clients to third-party registries for MIPS services.
• Is actively looking to add or expand specialty services.

Weak fit

• Fewer than 10 physician clients.
• Flat-fee billing model only.
• Already has a robust in-house MIPS coding team.
• Technology company masquerading as billing company.
• Offshore-first operation with no US-based quality infrastructure.
• Decision-maker is HR, receptionist, or non-billing role.

Our team wants to help your client’s increase billing events with pmpm revenue without seeing more patients, while maintaining their independence and/or control of the way they practice.

Referring your clients to our team helps you enhance prestige at NO cost. And this is obvious - when your clients’ reimbursement increases, so does your revenue. Since your commercial model is almost always performance-based, and you earn a percentage of client collections, the more Medicare billings you handle —the more your RCM benefits.

As an RCM, you can and should play a key role in helping your clients wherever possible. And with your help, our team can extend our MCCM Enhanced Relationship Care.

Most of your clients have hundreds or even thousands of Medicare patients eligible for Chronic Care Management, but their in-clinic nurses simply don't have time to spend 20 minutes a month on each non-visit care calls.

There can be no doubts that they have heard about Medicare CCM (MCCM) in the past, or may have participated and fell off. But the time has now come for another look.

The first reason, there is a federal bill currently moving through Congress, which means your clients should begin to identify eligible patients who already have secondary insurance and begin prepping the rest of their panel for when the bill passes (see below to learn more).

H.R. 8163 and H.R. 8261

These two bipartisan bills shall modernize the Medicare Physician Fee Schedule to address decades of declining physician reimbursement (the Provider Reimbursement Stability Act of 2026), and eliminate the co-payment that beneficiaries must agree to pay on Medicare CCM (the Chronic Care Management Improvement Act of 2026).

Please support the bills

 

Listen to the 6-minute Your Advocation is Needed Now-More-Than-Ever (mp3) and Click Here to download our support flyer (pdf).

However. until the day arrives when the cost-sharing requirement on chronic care management is eliminated, MCCM is still a great opportunity for your clients and their physicians and patients when done effectively.

Since 2015 – Poor utilization

Almost every medium-to-large medical group or practice manager has tried a third-party Chronic Care Management (CCM) or Remote Patient Monitoring (RPM) program vendor in the past.

These fully-outsourced contracts (staffing and all other services) had an initial set of enthusiasm with eligible patients and physicians — but almost always burned them.

The Problems:

• Almost all vendors utilize a flawed business model and fail to onboard and retain a sufficient number of eligible patients, and use unethical methods to meet onboarding goals.
• They promise 'turnkey revenue'—only to leave the clinic exposed to CMS audit risks, EHR documentation messes, or angry patients.
• Their care managers often skip minutes, log low-quality notes, or fail to meet strict CMS Incident-to-Billing Rules, putting the physician and clinic legally on the hook for False Claims Act violations.
• They call older patients, who are vulnerable to phone scams, sounding like a call-center agent, which confuses patients and makes them call the clinic upset, or leave a bad review.
• They promise "turnkey" service, but then bombard the front desk with questions, upset patients with robotic phone calls, or leave the clinic stuck trying to collect $15 co-pays from confused seniors who complain to the doctor.

To make matters worse, most vendors do not do the proper preliminary work required, set any proper level of expectations among physicians and staff, or offer any performance metrics beyond basic billing data:

• No Feasibility Analysis to build effective participation and success.
• No indication of how many patients are currently enrolled.
• No indication of what percentage of eligible patients enrolled.
• No software tools that report on staff efficiency; and
• No easy access to reporting on CPT billing.

This is the second reason, our team has developed the model that de-risks the operational and clinical worries, and delivers maximum value – MCCM Enhanced Relationship Care.

Our team:

• Is the ‘best-in-class’ at identifying MCCM feasibility and conducting program management.
• Skill-set, strategies, tools, and support provide the structure that ensures success.
• Deeply experienced in healthcare and large-scale program implementation and operations.
• Comprehensive understanding of regulatory requirements and advanced proprietary SaaS technology and continuous updates in response to industry changes, make their platform crucial for meeting quality metrics and achieving better patient outcomes.

Every note is time-stamped and fully compliant under strict CMS Incident-to-Billing Rules—meaning your clients and their physicians get 100% audit and liability proof protection and full visibility without their staff having to lift a finger or learn new software.

This makes them ideal for becoming your clients MCCM Enhanced Relationship Care management service partner.

Without an initial deep analysis, success is nearly impossible. And with SaaS technology, and a better guidance and support system – your clients and their physicians can double or even triple average enrollment and retention results. Creating more billable events.

Almost all vendors fail to provide a feasibility analysis, and /or possess the required tech. But this does not mean your clients and their physicians and patients must take a pass on the improved patient care and enhanced financial performance. The ROI from an MCCM Feasibility Analysis, is well worth their investment.

Our teams offering is built to help your clients and their physicians with evaluating, implementing, and operating MCCM Enhanced Relationship Care successfully. Here are the keys points:

• MCCM Feasibility Analysis – Should they participate in MCCM Enhanced Relationship Care? What are the metrics, physician profiles, and cultures that support success? What physicians and patients should be incorporated? Who shall hire / contract for mid-level billers? At what fee (if any) will the physicians be charged for mid-level services?
• Implementation – They develop and roll out clinical policies, audit-proof reassurance measures, and a low-friction patient micro-pilot. The initial Feasibility Analysis work includes education of administrative and clinical staff, developing patient education materials, setting up clinic responsibilities for patient onboarding, and micro-pilot patient selection (i.e. avoiding weak patient candidates). They shall run the micro-pilot on a small number of your clients eligible Medicare patients who have secondary insurance—where there is zero co-pay. Your clients don't commit their whole patient panel. They shall run care management for 60 days, log everything in your clients EHR, handle all care calls (2 monthly calling cycles), and prove the net revenue and patient satisfaction before your clients commit. With Congress moving to eliminate the 20% Medicare co-pay for its care codes, the biggest patient enrollment barrier is dropping. They help structure your clients panel so growth can be captured seamlessly.
• Software Operations – Their proprietary SaaS platform ensures clean documentation, denial control, and program management. It manages the scheduling, clinical documentation, telehealth / calling, and executive dashboarding. And it integrates with your clients EHR and billing system. And there is very little to learn.
• Clinical Staffing – Flexible staffing models support a range of clinic-level strategies. At the full concierge level, they hire, train, and manage all mid-level staff – which your clients have final approval on to work with their patients. This model can be either a permanent arrangement, or part of their MCCM Enhanced Relationship Care startup-strategy where our team phases out as your clients roll in their own employees.

In a 30-to-60-minute Zoom call meeting, we shall talk about our comprehensive solutions that will help your RCM and clients improve prestige and maximize financial performance.

Click Here or see the link below to go to our Calendly page to reserve your Zoom meeting.