Butler runs the between-visit contact for your Medicare patients, interprets every answer against the care plan, and sends only what needs a clinician to your team. The work is documented where you already chart it, and the claim is yours to bill.
APCM covers your whole attributed Medicare panel, not only the sickest patients, and it has no minute threshold. The limit was never eligibility. It was having someone to make the contact every month and write it down. We do that for the full panel and escalate by role.
Best fit: independent practices and risk-bearing groups with an attributed Medicare population and a care team already stretched thin.
Oncology, cardiology, nephrology, and neurology carry patients whose conditions qualify for navigation, and whose between-visit questions arrive as phone calls your nurses absorb. We run the check-ins between infusions, titrations, and dialysis decisions, and hand your team the ones that change care.
Best fit: practices treating serious, high-risk conditions where navigation is billable and the call volume is already a burden.
Your residents have primary care somewhere else, and the loop back to that clinician is the part that breaks. We keep contact going with the resident and the family, surface changes to the treating clinician, and give your team a written record instead of a hallway conversation.
Best fit: assisted living, independent living, and memory care operators who want clinical follow-through without hiring a nurse line.
Eight things that happened between visits. What arrived, what we did, and what the practice got back. Examples, with patients de-identified.
A scheduled check-in asked whether she had taken her lisinopril every day that week. She answered that she had missed two days because the bottle ran out.
The answer was read against her care plan, where the blood pressure goal and the medication were already recorded. Her most recent home reading came back above that goal, so the response was flagged rather than logged.
One item in the RN care manager's queue: refill lapse plus a reading above plan, with both values and the date, written back to the chart.
The visit three weeks later started from a known problem instead of a surprise. The month's contact and documentation supported the APCM claim.
A twice-weekly check-in collected his morning weight and asked about shortness of breath and swelling. The weight was up three pounds from the day before, and he mentioned sleeping on two pillows instead of one.
His plan set a weight-change threshold. This crossed it, and the pillow detail matched an orthopnea question already in his protocol, so it escalated the same day instead of waiting for the next scheduled contact.
A same-day escalation to the heart failure nurse with the weight trend, the symptom answers, and his current medication list, routed ahead of routine messages.
A diuretic adjustment happened by phone. No emergency department visit, and the navigation work was documented for PIN.
A daughter was named on her mother's care plan as the contact. After the diagnostic visit, the check-in went to both of them, and the daughter wrote back that she did not know what happened next.
The plan's navigation items became the contact schedule: safety at home, driving, medication routines, and caregiver support. Each answer was interpreted against the diagnosis rather than collected as free text.
A written summary of unmet needs, the questions the family wanted answered at the next visit, and a note that the daughter was managing medications without a list.
The neurologist spent the follow-up on decisions instead of orientation. Navigation for a serious, high-risk condition, documented as it happened.
He went home on a Monday with a new medication and a follow-up to schedule. The discharge summary reached the practice. Nobody had time to call him.
Contact started the day after discharge and continued on the cadence his plan called for, comparing what he was actually taking against the discharge list and asking about the follow-up appointment.
A reconciliation difference: he was still taking the medication the hospital had stopped. Routed to the clinician, with the follow-up visit already confirmed.
The transition closed without adding a call to anyone's afternoon. Contact and documentation in the same month as the claim.
Her protocol checked in between cycles on nausea, fever, mouth sores, and whether she was drinking enough. She reported a temperature she had not thought was worth reporting.
The temperature sat against her regimen and the day of her cycle, which is what made it urgent rather than ordinary. It escalated immediately, with the reading and the timing attached.
A flagged contact to the triage nurse the same morning, with her cycle day, the reading, and her answers to the rest of the check-in.
She was seen that day rather than over a weekend. Navigation between treatment visits, captured for PIN.
Staff noticed she was eating less and staying in her room. It was mentioned at shift change. Her primary care doctor, who works for a practice across town, heard nothing.
Her check-ins covered appetite, mood, and mobility, so the change showed up as answers over two weeks rather than an impression, with dates attached.
A written trend sent to her treating clinician, plus a flag to the community's nurse that the two were now looking at the same thing.
The building stopped being the only place that knew. One record, shared by the operator and the billing practice.
He had missed two appointments. The chart said no-show. The check-in asked what got in the way, and he said the ride never came.
Transportation was recorded as the barrier, not the behavior, and the next appointment was worked backward from getting him there. The need was documented in the form the practice needs for community health integration.
A social need on the record with a date, a confirmed appointment, and an item for the coordinator rather than the nurse.
Two no-shows became one kept visit. An unmet social need, identified and documented for CHI.
A walker was ordered at discharge. Six weeks later a check-in asked whether she was using it. She was not, because it never arrived.
The order was traced, the missing documentation identified, and the gap written up for the person who could actually resolve it. We do not alter the order or make the clinical case.
One administrative item with the order date, the supplier, and the missing piece named, sent to the coordinator instead of the physician.
She had it the following week, before the fall that was coming. Coordination documented against the month's plan.
We review your attributed panel and come back with who is eligible for which program, and which patients we would start with.
We read care plans from your EHR and draft protocols per patient. Your clinicians edit and approve them. Nothing goes out unapproved.
We run the contact by text. Routine answers are documented. Anything that warrants attention is routed by role to the person who should handle it.
You get the documentation that supports the claim, produced as the work happened, and a list of what your team acted on.
This is the part that separates us from an advocacy service. We are not the billing provider and we do not take the patient relationship. Your practice bills, using the documentation our contact produces.
| Program | Who it covers | Per patient, per month |
|---|---|---|
| APCM G0556 | One or fewer chronic conditions, anywhere in your attributed panel | $15.20 |
| APCM G0557 | Two or more chronic conditions | $48.84 |
| APCM G0558 | Two or more chronic conditions, Qualified Medicare Beneficiary | $107.07 |
| PIN G0023 | A serious, high-risk condition expected to last three months or more | $77.96 |
| CHI G0019 | An unmet social need that limits your ability to treat | $77.96 |
CY2025 national non-facility amounts. PIN and CHI each add $48.52 per additional 30 minutes, and CMS allows both to be billed in the same month as APCM for a patient who qualifies. CCM and PCM cannot be billed alongside APCM. Each program needs an initiating visit and documented consent, and cost sharing applies.
No. We read the plan your clinicians wrote and build the contact schedule and questions from it. Your clinicians approve every protocol before it runs, and we do not diagnose, prescribe, or alter instructions. Clinical questions go back to the treating team.
That is the failure mode we were built to avoid. Routine answers are documented back to the chart and no one is paged. Only responses that warrant attention are routed, and they arrive already interpreted, attributed to a role, and written into the record you already use.
You do, on both counts. We work under your practice, the documentation lands in your chart, and the claim is yours. We do not enroll your patients into a separate service or put our phone number in place of yours.
We read the care plan and write the interaction back. Where an interface exists we use it, and where it does not we work the way your team already does. Tell us your system on a call and we will tell you exactly what the integration looks like.
Answer a text. There is no portal, no app, and no login. Patients who do not respond are followed up on a schedule, and patients who ask for a person get one from your team, not a stranger.
The record is produced as the work happens, not reconstructed at the end of the month. Each contact carries its date, the questions asked, the patient's answers, the interpretation, and the role it was routed to.