RPM/RTM Revenue Calculator

00 Customer Persona: Telemark Health Segment B Device-Enabled RPM Operator ▼

Tracks
RPM-HTN + RPM-HF

Stage
18 months in (May 2026)

Enrolled
~2,400 patients

Ops Model
Clinician-led + cellular devices

Storyline
"The Engagement Cliff"

Company Profile (Composite Archetype)

Company

Telemark Health

Series A virtual hypertension & heart failure RPM startup. ~$28M raised across seed + Series A. Composite archetype modeled on the early-stage profile of companies like Cadence (pre-Series B), Story Health, and Heartbeat Health.

What They Do

Direct-to-patient virtual care for Medicare beneficiaries with hypertension and heart failure. Ship cellular-enabled BP cuffs and weight scales to enrolled patients, then provide ongoing monitoring + medication titration through their own NP and clinical pharmacist team. Bills RPM codes (99453/99454/99457/99458) under their own organizational NPI. The model that real RPM operators converge on — see Cadence's published outcomes for the mature version of this archetype.

Clinical Workforce	~18 NPs (W-2, full-time), ~6 clinical pharmacists, ~12 MAs for device logistics. Cardiologist medical director (part-time).
Primary Markets	FL, TX, AZ initially; expanding to NC, GA. Targeting Medicare FFS in retirement-dense MSAs.
Medicare Status	Organizational NPI active. Billing live since month 4. ~14 months of claims history.
Devices	Cellular BP cuffs (no smartphone required) + cellular weight scales for HF patients. ~$120 unit cost, 18-month device life.
RPM Revenue	~$2.3M ARR run-rate based on current panel + engagement. RPM-only (RTM would require a disjoint patient cohort due to dual-billing rules).

1Phi Segmentation

Segment	B Device-Enabled RPM Operator
Mindset	Unit-economics operator
Ops Model	Clinician-led + device-enabled
GTM Orientation	Provider-referral + direct Medicare
Price Model	Fee-for-service Medicare billing
Friction Point	Every billable patient-month requires both device compliance (≥2 days) and clinician time (≥10 min) — engagement gaps drop revenue to $0 fast

Capability vs. Track Requirements

Track	Condition	Telemark Capability	Notes
RPM	Hypertension	Strong — cellular BP cuff + NP titration	Core program (~80% of panel)
RPM	Heart Failure	Strong — daily weight + symptom checks	~15% of panel; higher-touch
RPM	Diabetes	Moderate — no CGM yet, scale only	Roadmap, not in baseline

Our Story (Synthetic Data Narrative)

Setting the Scene

Telemark launched their hypertension program in late 2024 and started billing Medicare in month 4. Eighteen months in (May 2026), they've enrolled ~2,400 patients across FL, TX, and AZ. The board sees a clean revenue ramp on the gross panel-size chart — but the CFO knows the per-patient math is messier than the deck suggests.

Roughly 60% of patient-months hit the 16-day device threshold needed for the full 99454 rate. About 70% of those device-compliant patients get the live 20-minute interaction required for 99457. The rest fall into the new 2026 lower-tier codes (99445/99470) — or generate no bill at all that month.

The Engagement Cliff

RPM revenue is binary at the patient-month level. Hit 16 device-days and bill $52; miss it by one day and either drop to $47 (new 99445) or zero (no bill). Hit 20 minutes with a live conversation and bill $52; fall short and either drop to $26 (new 99470) or zero. Every patient sits on a cliff, every month. The new 2026 codes soften the cliff but don't eliminate it — and most operators have no real-time view of where each patient sits.

01 RPM/RTM Revenue Calculator RPM-HTN + RPM-HF — Telemark Health — 18 months

Enrolled Patients iTotal patients currently enrolled across RPM tracks. ~85% HTN, ~15% HF.

2,400

+8% MoM

Monthly Revenue (Run-Rate) iSum of allowed amounts billed this month across all enrolled patients. Driven by panel size × the patient-month code mix. No withhold — RPM/RTM is pure fee-for-service.

$193K

$80.50 / patient / month avg

Device Compliance i% of patient-months hitting 16+ days of device data transmission. Drives 99454 billing ($52). Below 16 days but ≥2 days drops to new 2026 code 99445 ($47). Below 2 days — no device-side billing. Industry benchmark: Cadence reports 84%.

62%

Industry best-in-class: 84%

Management Completion i% of patient-months where clinical staff hit 20+ min of time AND ≥1 live interactive communication. Drives 99457 ($52). Between 10-19 min drops to new 2026 code 99470 ($26). Under 10 min — no management billing.

71%

Of device-compliant patients

Avg Add-On Units iAverage 99458 add-on units per managed patient-month. Each add-on = +20 minutes beyond the first 20. Max 2 per month by CMS rule. HF patients average higher (~0.7) than HTN (~0.2). Each unit bills $41.

0.31

Avg per managed patient-month

Active Devices iNumber of cellular BP cuffs + weight scales currently deployed in the field. Should track close to enrolled count minus churned-but-not-returned devices.

2,340

98% device deployment

New Setups (99453) / Month iPatients onboarded this month who triggered the one-time 99453 setup fee ($22). Drives the small "step up" in monthly revenue when growth is strong.

186

$4,092 setup revenue this month

Zero-Bill Patients iPatients enrolled but generating no billable code this month — missed both device and management thresholds. Pure cost (device amortization + overhead) with no offsetting revenue. Re-engagement target.

347

14% of panel

Avg Sessions / Mo iAverage number of clinical encounters (phone, video, or messaging with live response) per enrolled patient per month. Drives 99457/99470 eligibility. Target ≥1.0 to ensure interactive communication requirement is met.

1.1

Target: ≥1.0 for billable mgmt

Monthly Churn i% of enrolled patients leaving the program this month (disenrollment, death, transferred care). Industry typical for RPM is 2-4% monthly. Lowers net growth rate.

3.2%

~75 patients/mo

Monthly Revenue Composition — by Patient Story Fee-for-service, stacked by code combination per patient-month Preset

Model my practice

Three questions. We'll project a smooth 24-month ramp from launch using a documented S-curve for enrollment and engagement maturity. Coupled so you can't accidentally build an implausible mix.

Panel at Month 12 target enrolled

1,200

How many patients do you expect to have enrolled by the end of year 1?

Ramp Speed months to maturity

How quickly do staff & patients hit steady-state engagement?

Steady-State Quality end of ramp

Where do device-compliance / mgmt-completion settle after ramp?

Modeling assumptions: enrollment follows a logistic S-curve to your month-12 target then continues at ~3%/mo; device-compliance and mgmt-completion ramp from 25%/30% (launch) to the steady-state values you select, on the ramp-speed schedule; add-on intensity (99458) ramps from 0.05 to a level matched to your quality choice. All engagement microstructure constants held at field-tested defaults (65/70/50) — switch to Case Study mode to tune them.

Net Panel Growth Actual: ~8%/mo

+8%

New enrollments minus churn

Device Compliance % ≥16 days

62%

Remainder splits via Engagement Microstructure below

Mgmt Completion % ≥20 min + live

71%

Of device-compliant patients

Avg Add-On (99458) Per mgd pt-month

0.31

Max 2.0 per CMS rule

Engagement Microstructure Advanced — how engagement misses distribute across new partial-credit codes ▼

Engaged bundle (99454+99457+99458) Standard bundle (99454+99457) Device only (99454 or 99445) Low-touch (99445+99470, new 2026) Onboarding (99453)

Export Export to Google Sheets

Generates a Google Sheet with full data and calculations:
• Data tabs — patient roster, device-day logs, time logs
• Calculator tabs — formulas driving the patient-story decomposition
• Scenarios tab — editable what-if workspace

All formulas are transparent and editable. Snapshot at export time.

Patient-Story Decomposition

Every chart bar above is built from these ten patient-month archetypes. Every enrolled patient generates exactly one story per month — the calculator counts how many patients land in each bucket given the slider settings, then multiplies by the 2026 PFS rate for that bundle. CMS pays per code, not per patient-month, but operators think in stories. The "engaged" and "off" cards are the two ends of the value distribution; the middle cards are what most patient-months actually look like.

1 · Onboarding only

99453

$22

First month after enrollment, one-time

2 · Onboarding + first month

99453 + 99454 + 99457

$126

Strong launch: device hits 16+ days, mgmt hits 20 min

3 · Onboarding + first month engaged

99453 + 99454 + 99457 + 99458

$167

High-touch launch with 40+ min mgmt

4 · Steady-state device only

99454

$52

Device compliant but no live conversation that month

5 · Steady-state standard

99454 + 99457

$104

The modal steady-state month for engaged patients

6 · Steady-state engaged

99454 + 99457 + 99458

$145

High-acuity HF or labile-HTN patient with 40 min mgmt

7 · Steady-state max

99454 + 99457 + 99458 × 2

$186

60+ min mgmt — rare, post-discharge or complex titration

8 · Off month

— no bill —

Device < 2 days AND mgmt < 10 min — common in disengaged tail

9 · NEW 2026 · Low-touch

99445 + 99470

$73

Device 2-15 days + mgmt 10-19 min · partial-credit floor

10 · NEW 2026 · Partial-mgmt

99454 + 99470

$78

Device compliant + brief check-in · saves the bar

Why the 2026 codes matter: 99445 and 99470 are new partial-credit codes finalized in the CY 2026 Medicare PFS Final Rule. Before 2026 a patient with 10 device-days and 12 mgmt-minutes was a $0 month. In 2026 that same patient is a $73 month (story 9). For the current panel where ~34% of patient-months fall in these new-code windows (computed live from sliders), the 2026 codes are worth roughly ~$697K/year of revenue that was previously left on the table (nSight Care 2026 RPM guide; figure recomputes when you move the sliders above). Code mutual-exclusivity: 99454 ⊕ 99445 (device tier) and 99457 ⊕ 99470 (mgmt tier) — pick one of each pair per patient per month.

Monthly Revenue Detail — 18 Actuals + 12 Projected ▼

02 Algorithms & Calculations The math behind the sliders ▼

CALC-01 Payment Timing — Pure FFS, Monthly Claim, No Withhold

RPM/RTM payments are per-claim, per-patient, per-month. There is no withhold and no quarterly reconciliation. Each CPT code is billed independently for the patient-month and paid at the 2026 PFS national average within ~14–30 days under standard MAC claims processing.

For each enrolled patient, each calendar month:
bill_lines = []
IF first month after device delivery AND consented:
bill_lines += 99453 ($22, one-time per episode)
IF device_days >= 16: bill_lines += 99454 ($52)
ELSE IF device_days in [2,15]: bill_lines += 99445 ($47) // NEW 2026
IF mgmt_minutes >= 20 AND live_interaction: bill_lines += 99457 ($52)
AND additional 20-min blocks: bill_lines += 99458 ($41) each
ELSE IF mgmt_minutes in [10,19]: bill_lines += 99470 ($26) // NEW 2026

monthly_revenue_patient = SUM(bill_lines)
org_monthly_revenue = SUM over all enrolled patients

Unlike ACCESS or other value-based programs, there are no quarterly spikes or dips — the chart above is smooth because cash flow is smooth. Volatility comes entirely from the composition of patient-months: how many patients hit which engagement thresholds.

CALC-02 Per-Code Rates — 2026 PFS National Average

Rates below are CY 2026 Medicare PFS national average non-facility, $33.40 base conversion factor (or $33.57 for qualifying APM participants). Geographic locality adjustments (GPCI) move rates ±5-15% by region; commercial payers vary widely (~70-130% of Medicare).

CPT	Description	Period	2026 Rate	Threshold
99453	RPM device setup & patient education	One-time per episode	$22	Consented + device shipped
99454	RPM device supply, daily transmissions	30-day period	$52	≥16 device-days
99445 NEW 2026	RPM device supply, partial	30-day period	$47	2–15 device-days
99457	RPM treatment mgmt, first 20 min	Calendar month	$52	≥20 min + live comm
99458	RPM treatment mgmt, add-on 20 min	Calendar month	$41	Each additional 20 min
99470 NEW 2026	RPM treatment mgmt, brief	Calendar month	$26	10–19 min
RTM (MSK pilot — 5% of panel)
98975	RTM device setup	One-time per episode	$20	Consented + device delivered
98977	RTM device supply, MSK	30-day period	$40	≥16 device-days
98980	RTM mgmt, first 20 min	Calendar month	$54	≥20 min + live comm
98981	RTM mgmt, add-on 20 min	Calendar month	$41	Each additional 20 min

Sources: nSight Care 2026 RPM CPT guide · Tenovi 2026 RTM codes · CMS CY 2026 PFS Final Rule.

CALC-03 Patient-Story Decomposition

Every enrolled patient-month resolves to exactly one of ten archetypes shown in Section 01. Given the slider inputs (device-compliance %, mgmt-completion %, add-on avg, growth %), the calculator distributes the enrolled population across these buckets using the conditional probabilities below.

Step 1 — Device tier (driven by device-compliance slider d):
f_device_full = d // 99454 eligible
f_device_partial = (1 - d) * 0.65 // 99445 eligible (NEW 2026)
f_device_none = (1 - d) * 0.35 // no device bill

Step 2 — Mgmt tier conditional on device tier (slider m):
// patients with full device get higher mgmt completion (correlation ~1.4×)
mgmt_full | device_full = m
mgmt_full | device_partial = m * 0.7
mgmt_partial | mgmt_miss = 0.5 // half of mgmt-misses still hit 10 min

Step 3 — Story assignment:
story_5_standard = f_device_full * m_full * (1 - p_addon)
story_6_engaged = f_device_full * m_full * p_addon
story_10_partmgmt = f_device_full * m_partial // 99454+99470
story_4_deviceOnly = f_device_full * (1 - m_full - m_partial)
story_9_lowTouch = f_device_partial * (m * 0.7) // 99445+99457
story_8_off = f_device_none
... etc.

The 0.65 partial-device factor reflects field observation that most non-compliant patient-months are still 2–15 device-days (technical issues, missed weekends) rather than true device-none. The 0.7 mgmt-correlation factor reflects that engaged-on-device patients are also more reachable by phone.

CALC-04 Slider-to-Revenue Math

The four sliders map directly to the decomposition above. Sliders are deliberately exposed at the engagement layer rather than per-code, because operators think in terms of "how many of my patients hit 16 device-days", not "how many 99454s did I bill".

Per patient-month expected revenue:
E[$/pt-mo] = f_story_5 * $104
+ f_story_6 * ($104 + p_addon * $41)
+ f_story_10 * $78
+ f_story_4 * $52
+ f_story_9 * $99
+ f_story_8 * $0
+ f_lowLow * $73 + f_partialOnly * $47

Monthly org revenue:
$org = enrolled[t] * E[$/pt-mo] + new[t] * $22

Enrollment growth (slider g, monthly):
enrolled[t+1] = enrolled[t] * (1 + g/100)
new[t+1] = enrolled[t+1] - enrolled[t] + churned[t]
churned[t] = enrolled[t] * 0.02 // 2%/mo industry average

The 2%/mo churn assumption is grounded in Prevounce's 2026 RPM economics analysis, which reports 22-28% annualized panel churn as the industry median. Best-in-class operators like Cadence publish 84% device-compliance as their benchmark, vs the 60-65% median observed across mid-stage RPM startups.

CALC-05 Add-On Logic (99458)

99458 is uniquely valuable because it stacks. A patient who gets 60 minutes of management generates 99457 + 2× 99458 = $52 + $82 = $134 just for mgmt. Most operators leave 99458 on the table — the add-on slider models how aggressively the clinical team documents and bills additional 20-min blocks.

addon_revenue_per_patient = avgAddon * RATES.c99458

// avgAddon = expected count of 99458 add-ons per engaged patient per month
// Realistic baseline: 0.31 (rough average across patient panel)
// Best-in-class: 0.75 (Cadence-grade documentation discipline)
// Theoretical max: 2.0 (would require 60+ min mgmt on every engaged pt)

addon_org_revenue = enrolled * f_engaged * avgAddon * $41

For Telemark's current panel, moving the add-on slider from 0.31 to 0.75 — a documented best-practice intervention — is worth an additional ~$19K/month at steady state without enrolling a single new patient (computed live from the current device + mgmt sliders, which determine how many patients are in the engaged bucket where the add-on applies). This is the engagement-cliff lever.

CALC-06 New 2026 Codes — Mutual Exclusivity

CMS designed the new partial-credit codes (99445, 99470) as mutually exclusive with their full-credit siblings. A single patient-month can bill either 99454 or 99445 — never both. Same for 99457 vs 99470. This is the partial-credit cliff the CY 2026 rule is designed to soften.

// Device tier — pick ONE per patient-month:
IF days >= 16: bill 99454 ($52)
ELSE IF days >= 2: bill 99445 ($47) // partial credit
ELSE: no device bill ($0)

// Mgmt tier — pick ONE per patient-month:
IF minutes >= 20 AND live: bill 99457 ($52) + N * 99458 ($41 each)
ELSE IF minutes >= 10: bill 99470 ($26) // brief, no add-on
ELSE: no mgmt bill ($0)

// 99470 CANNOT be combined with 99458 add-on

The clinical implication: documentation discipline matters more than ever. A 12-minute call that previously yielded $0 now yields $26. A 19-minute call yields $26 — but a 20-minute call yields $52 plus an add-on opportunity. The 20-minute threshold remains the high-leverage operational target.

CALC-07 Preset Modes — Realistic vs Best-in-Class

Realistic preset (Chicagoland-grounded):
device_compliance = 62% // 1Phi notebook median
mgmt_completion = 71% // 1Phi notebook median
avg_addon = 0.31 // ~1 in 3 engaged pts get an add-on
net_growth = 8% // Series A growth rate

Best-in-class preset (Cadence-grade):
device_compliance = 84% // published Cadence benchmark
mgmt_completion = 88%
avg_addon = 0.75 // disciplined documentation
net_growth = 8% // same growth rate

delta_revenue_psm = E[$/pt-mo | best] - E[$/pt-mo | realistic]

The presets exist to quickly demonstrate the operational lift available without changing TAM. For Telemark, the realistic→best-in-class delta is roughly +$32/pt/mo, or ~$77K/month at the current panel (computed live from sliders). That's the "engagement cliff" investment thesis in one number.

CALC-08 RTM Stacking — Out of Scope

RPM and RTM cannot be billed concurrently for the same patient in the same calendar month for the same condition (CMS dual-billing rule). RTM revenue therefore does not stack onto an RPM panel — it would require a separate, disjoint patient cohort with a different qualifying condition (typically MSK or respiratory).

Modeling that disjoint cohort cleanly requires its own enrollment, eligibility, device-day, and time-log streams, which is outside the scope of this calculator. RTM rates are kept in the CALC-02 reference table for completeness, but no RTM revenue is included in the chart, the headline metrics, or the projection.

If you need RTM revenue modeling, build it as a parallel calculator with its own panel, not an addition to this one.

03 Data Model Customer-provided · CCW match · derived intelligence ▼

The calculator consumes three data domains. Domain 1 is what the RPM operator already has in their own platform. Domain 2 is what 1Phi adds via CCW bene-match: dedup against other RPM billers and Medicare FFS eligibility. Derived is the patient-month decomposition that powers every chart bar and slider above.

Domain 1 Customer-Provided Data

What the RPM operator uploads or streams from their own platform. They already have it — 1Phi just standardizes the schema and computes monthly summaries.

Table	Key Fields	Frequency	Purpose
Enrollment	patient_id, enrollment_date, consent_date, device_ship_date, condition_codes, state, zip, payer	On enrollment	Who is in the program · 99453 trigger
Device-Day Log	patient_id, date, device_type, reading_count, threshold_met (bool)	Daily (auto from device)	99454 vs 99445 vs nothing eligibility
Time Log	patient_id, calendar_month, mgmt_minutes, live_interaction (bool), staff_id	Per encounter	99457 vs 99470 vs nothing · 99458 add-on count
Communication Log	patient_id, date, channel (phone/video/secure msg), duration_sec, was_synchronous	Per encounter	"Live communication" attestation for 99457
Disenrollment	patient_id, end_date, reason	On exit	Churn tracking · denominator correction

Domain 2 CCW Bene-Match Intelligence

What 1Phi reveals by matching the customer's patient roster against the CMS Chronic Conditions Warehouse. The operator cannot see this on their own. Critical for RPM because CMS only pays one provider per patient per month for 99454.

Table	Key Fields	Frequency	Purpose
Match Result	match_confidence, is_medicare_ffs, mbi_hash, beneficiary_state	Per match job	FFS eligibility — required for billing
Concurrent Billing Conflict	has_other_rpm_biller, other_npi, last_99454_date, last_99457_date	Per match job	Dedup — avoid claim denials
Comorbidity Profile	chronic_conditions (HCC), prior_inpatient_30d, ed_visits_180d	Per match job	Risk stratification · disjoint-cohort RTM eligibility

Derived 1Phi Patient-Month Intelligence

Computed by joining Domain 1 + Domain 2. One row per patient per month. This is what the chart and sliders consume.

Table	Key Fields	Frequency	Purpose
Patient-Month Summary	patient_id, calendar_month, device_days, mgmt_minutes, story_id (1–10), billed_codes[], expected_revenue, blocked_reason	Monthly	The atomic record · one row drives one billing decision
Story Distribution	calendar_month, story_id, patient_count, total_revenue, % of panel	Monthly	What feeds the stacked bar chart
Monthly Org Summary	calendar_month, enrolled, new_enrolled, churned, gross_revenue, avg_per_patient, addon_attach_rate	Monthly	Headline metrics · trend line on chart
Engagement Cliff Tracker	patient_id, current_device_days, days_to_eom, projected_story, $ at risk	Daily (real-time)	The actionable layer — who needs a call today to hit 99454

Why the domain split matters for RPM/RTM: The operator can see Domain 1 perfectly — they own the device data and the time logs. What they typically miss is Domain 2: a patient enrolled in two RPM programs simultaneously will trigger a CMS denial on the second-billed 99454, and Medicare FFS eligibility status changes monthly with Advantage plan enrollments. Without the bene-match, those denials show up 30–90 days late as cash variance. The Engagement Cliff Tracker is the daily-ops view that's missing from most internal dashboards — knowing on day 22 of the month that 180 patients are sitting at 14 device-days and need a call is worth more than any retrospective analytics.

04 Data & Workflow From operator platform to calculator to Google Sheets ▼

Two Modes

The calculator works at two levels of data richness. Both produce the same chart — the difference is whether the bars are computed from real device/time logs or from slider-driven assumptions.

What-If Mode

No patient data needed. Operator (or prospect) sets panel size, picks a preset (Realistic vs Best-in-Class), and plays with the four sliders. Useful for board decks, fundraising models, and operational target-setting.

Inputs: Panel size · growth % · 4 engagement sliders
Chart: 100% projected — all bars are synthetic

Data-Driven Mode

Operator has uploaded Domain 1 (enrollment, device-day logs, time logs, comm logs) and 1Phi has run the CCW bene match. Past months show actual story distribution; future months use sliders as forward assumptions.

Inputs: Patient data (D1) + bene match (D2) + projection sliders
Chart: Actuals (solid bars) → Projected (dashed trend)

Data Flow (Data-Driven Mode)

Target Panel Defined

Condition focus (HTN, HF, etc.)
Geographic markets
Eligible Medicare FFS sizing
Device strategy chosen

→

Operator Data Uploaded

Enrollment roster (CSV/API)
Device-day log (auto from device cloud)
Time log (from EHR or app)
Communication log (from telephony)

→

1Phi Bene Match

Medicare FFS confirmation
Concurrent-biller dedup (other NPIs)
Comorbidity + risk profile
Disjoint-cohort RTM eligibility flag

→

1Phi Computes

Patient-month story assignment
Per-code expected revenue
Engagement cliff tracker (real-time)
Forward projection w/ sliders

Delivery: Google Sheets Export

The calculator exports as a Google Sheet — data tabs with raw records, calculator tabs with formulas mirroring the JS above, and a scenarios tab for custom modeling. Generated from a master template, snapshot at export time. Live sheets sync on-demand, not real-time.

Tab	Contents	Source	User Interaction
Data: Patients	Patient-month rows, device-days, mgmt-minutes, story assignment	D1 + Derived	Read-only reference
Data: Bene Match	FFS status, concurrent billers, comorbidities	D2	Read-only reference
Data: 2026 Rates	CPT codes, national rates, thresholds, mutual-exclusivity rules	Reference	Read-only reference
Calculator: RPM	Monthly revenue model, story decomposition, projection	Derived	View results, edit sliders
Scenarios	What-if workspace · realistic/best-in-class/custom presets	User input	Operator plays here

Update Cadence

Sheets are exported on-demand — not live-connected. For fresh data, re-export. Device-day logs are the freshest input (auto-syncs daily); CMS rate updates happen annually with the PFS Final Rule.

Data Type	Update Source	Frequency
Device-day logs	Auto-sync from device cloud (Tenovi, BodyTrace, Omron, etc.)	Daily
Time logs / mgmt minutes	EHR integration or staff app entry	Per encounter
Enrollment / disenrollment	Operator CRM	Weekly or real-time API
CCW bene match	1Phi runs against quarterly CMS data refresh	Quarterly
CMS PFS rates	Published by CMS (final rule in Nov, effective Jan)	Annually

Calculator vs Real Billing

This calculator estimates expected revenue from RPM/RTM CPT codes given operator-controlled engagement parameters. It is not a billing system. Real claim outcomes will diverge for several reasons:

Denials and rework: 5–12% of claims are denied first-pass; ~80% are recoverable on rework. Net cash typically lands at 92–95% of gross expected.
Geographic locality (GPCI): The national-average rates above vary ±5-15% by MAC region. Telemark's FL/TX/AZ markets sit close to national average; CA or NYC operators see 10-15% uplift.
Payer mix: Medicare Advantage plans contract individually — most pay 95-105% of Medicare FFS, but a few pay flat per-member-per-month rates. Commercial RPM coverage is wildly variable.
Compliance discounting: Some operators apply a 5-10% reserve for potential RAC/UPIC audit findings on RPM documentation. The calculator does not model this.
Cash timing: The chart shows accrual (date of service), not cash. Real cash lags 30-45 days for clean claims, longer for denied-then-reworked.