For federally qualified health centers (FQHCs), rural health clinics, and primary-care practices
Care between visits is done every month and billed almost nowhere.
Medicare now pays monthly for advanced primary care management (APCM), chronic care management (CCM), community health integration (CHI), and principal illness navigation (PIN). Fewer than one in ten organizations bill the community codes at all, because the evidence a billing department will accept does not exist where the work happens. Kept Count runs the month beside your electronic health record (EHR), and hands your biller one reviewed packet per member-month.
A business associate agreement is signed with every customer before any patient data moves.
One month, lined up for billing review
IllustrationCare manager · this month's panel
Sep 22 · 8 days left
- R.M.Community health integration64 of 60 min · reviewed Ready
- D.O.Principal illness navigation38 of 60 min · 22 to goIn progress
- A.K.Advanced primary care managementConsent not on file yet. Ask at the next call.Held
- J.S.Community health integrationNeeds an initiating visit with Dr. P. first.Held
Uses the staff you have
Kept Count adds no new positions. The roles are hats your team already wears.
A two-person team runs the full program. Larger centers split the hats across more people. Nobody hires a new role.
Your care coordinator
An RN, MA, or CHW calls patients and logs the time. The same person can also enroll patients and run the team.
Your billing practitioner
Reviews ready months in about an hour a week and answers care-team questions. APCM months ready for sign-off can be signed together in one batch, or a center can choose to skip physician review for APCM.
Your billing staff
Export approved lines into the billing system you already use.
What you lose today
The work happens. The month doesn't show it.
- 01
The work is done and never billed
Care coordinators, nurses, and community health workers spend the month on calls, refills, referrals, and follow-through. None of it reaches a claim because no one can produce the consent, the time, and the supervision on the same page.
- 02
The month that is billed cannot survive a records request
Chronic care management is on the work plan of the HHS Office of Inspector General (OIG). A month billed from a spreadsheet, or from notes with no timestamps, is a month you may have to pay back with interest.
- 03
Medicare Advantage and QMB are guessed, not verified
A Medicare Advantage (MA) member billed at Medicare rates, or a Qualified Medicare Beneficiary (QMB) billed cost-sharing, is a finding waiting for a payer to notice. Payer type and QMB status are a fact of the month, not an assumption.
What pays you
The codes and tiers behind the month.
These are the Medicare fee-for-service codes a health center or practice can bill for work its care team already does. Each is paid per enrolled member per month, on top of the visit.
G0556
APCM level 1, one or fewer chronic conditions
$16.37
Per member per month. No minute threshold. Consent, the initiating visit, and the practice-level capabilities carry the claim.
G0557
APCM level 2, two or more chronic conditions
$53.78
Per member per month. The tier most enrolled members land in. Held when the condition count is not documented.
G0558
APCM level 3, two or more conditions and QMB
$117.24
Per member per month. QMB status is verified before the tier is assigned, and a QMB member is never billed cost-sharing.
99490
CCM non-complex, first 20 minutes
$66.13
Per member per month. Time-based, so every minute is server-timestamped, and the same member cannot carry CCM and APCM in one month.
G0019 and G0022
Community health integration
Per your fee schedule
Monthly, time-based, furnished by auxiliary personnel under general supervision after an initiating visit by the billing practitioner. Rate per your fee schedule.
G0023 and G0024
Principal illness navigation
Per your fee schedule
Monthly, time-based, for a serious high-risk condition after an initiating visit. Rate per your fee schedule.
99424 to 99426, 99495 and 99496
Principal care management and transitional care management
Per your fee schedule
Configured as codes with exclusion rules against the same-month families. Rates per your fee schedule.
99492 to 99494, G2214
Collaborative care and behavioral health integration
Per your fee schedule
Configured as add-on families with their own exclusions. Remote physiologic monitoring runs the same way. Rates per your fee schedule.
CY2026 Medicare Physician Fee Schedule national non-facility rates, verified September 7, 2026. Confirm against your MAC locality fee schedule before relying on any figure. Codes shown without a rate are paid on your fee schedule and are not priced on this site.
How the month runs in Kept Count
One month, start to packet.
Each step is shown on synthetic data. Your roles, your rules, and your month close run the same way in the workflow session.
- 01
Eligibility and payer type at intake
The panel scanner classifies every member by program fit, chronic condition count, QMB status, and payer type. Medicare Advantage members are held until a payer-specific rate is verified, never counted at Medicare rates by default.
Synthetic data - 02
Consent once, recorded with who, how, and when
Verbal or written consent is captured a single time and attached to every month that follows. Cost-sharing disclosure is part of the record, and a QMB member is flagged so no cost-sharing is ever billed.
Synthetic data - 03
Time evidence that a reviewer can trust
Every action is server-timestamped against the member and the code family. Time-based codes accrue minutes. APCM months accrue the elements the claim depends on. A care manager cannot backdate.
Synthetic data - 04
Exclusion rules enforced in the database
CCM and APCM in the same month, PIN and CHI on the same condition, a second month for the same member: each is rejected by a trigger before the entry exists. The rule is data, maintained by a certified coding professional, not logic buried in the application.
Synthetic data - 05
Supervisor review before anything is called supported
A supervisor sees every member-month as supported, held, or unknown, with the reason. Holds are worked or documented. Nothing is auto-approved.
Synthetic data - 06
A hashed packet per member-month
Month close produces one packet per member-month: consent, eligibility, time, supervision, and the reason for every hold, hashed so it cannot change after review. Your billing department codes and submits from that packet.
Synthetic data
Proof that applies to you
Tested in the open, on synthetic data, before any customer.
Every claim below is checked in the codebase and documented on the proof page. None of it is a customer result, and none of it is a promise of payment.
10,000 synthetic members, 29,100 patient-months
A certified synthetic run of the full platform: 24 navigator panels capped at 250, every expected code and hold reason matched, zero patient rows visible across panels or organizations.
Exclusion rules enforced in the database
A same-month conflict between code families is rejected by a database trigger before the time entry exists. Application code cannot route around it.
Row-level security on every table
Access is checked at the database, scoped to the organization that owns the row. No table relies on an open policy.
Fresh-database replay in the release gate
Every migration replays in order against a brand-new disposable database in continuous integration, then runs the security tests, before a release is trusted.
What Kept Count will never do
The boundaries are the product.
Care-management software earns trust by making responsibility easy to inspect. These are the lines Kept Count holds for you, on purpose.
Kept Count never bills a payer
Your coders code. Your billing department submits. Kept Count produces the packet they review. The authority that carries the audit risk stays with the organization that holds it.
Kept Count never auto-approves a month
A month is supported only after the billing practitioner has reviewed it. Software that approves its own work has nothing to show an auditor.
Kept Count never replaces your EHR
The clinical record stays where it is. Kept Count runs the program month beside it and hands the result back as a packet, not as a second chart.
Questions this buyer asks
Answered directly.
We already bill CCM. What changes?
Two things. First, every CCM month gains the consent, timestamps, and supervision an auditor will ask for, so the months you already bill can survive a records request. Second, APCM, CHI, and PIN come into the same month with the exclusion rules enforced, so the members you cannot bill under CCM are no longer left out.
Our care team is small. Is this worth running?
The program is per enrolled member-month, so it scales down as well as up. A two-person team, a care coordinator and the practitioner who bills, runs the full program: no new positions, just the hats your team already wears. The workflow session runs your actual panel size through the model.
How does this fit with our EHR?
Kept Count is the operating layer beside the chart. Members and eligibility come in by file at first. The clinical record never moves, and nothing is written back to the EHR without your integration decision.
What happens when a rule changes at the next fee schedule?
Codes, rates, and exclusions are data in Kept Count, not code. They are reconfigured for each CMS rule cycle by a certified professional medical auditor and reviewed with you, with the prior configuration kept for months already closed.
Can we evaluate this without exposing patient data?
Yes. The public site and the workflow session run entirely on synthetic data. Kept Count is designed for covered operation, and a business associate agreement is executed per customer before any protected health information enters a dedicated environment.
Next step
Bring one month of your program. We will show you what it is worth and what it takes to count it.
A workflow session runs your roles, your panel, and your month-close through Kept Count on synthetic data. No patient information, no agreement, no cost.