Introducing FairPath.AI

Safe and Understandable AI-Powered Software to Transform your RPM, RTM, CCM, and APMC Program

FairPath helps practices run profitable remote care programs—without audit risk, billing confusion, or compliance gaps. FairPath Pro goes further, managing your entire RPM operation end-to-end.

Built for Dynamic Regulatory
Environments

With the increased scrutiny and regulatory demands for running remote care programs, software that handles sudden regulatory changes is more important than ever. FairPath is an intelligent compliance management system purpose-built for remote care programs facing dynamic, demanding regulatory environments.
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Patient Consent & Education Automation
Real-time, HIPAA-compliant audio recordings and transcriptions during onboarding.
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Continuous Patient Compliance
Automated text and AI-driven interactions significantly boost patient adherence, while providing verifiable communication records.
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Audit-Ready Documentation
Automated, timestamped, tamper-proof documentation of every clinician interaction.
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Real-time AI Oversight
Proactively flag potential compliance gaps before claims submission, ensuring no critical data goes missing post-submission.
The Tech Under the Hood
Our proprietary ontology engine Buffaly allows us to catch up to fluid regulatory changes at higher times than the competition, while ensure interoperability between disparate systems like ICD-10, SNOMED, and CPT®.

If regulations change, we change. Fast. No need to wait for slow rollouts.
The Intelligence Factory Difference

How We Empower Your Practice

The FairPath platform has processed over 1.1 million claims and recovered more than $36.7 million. By training FairPath on millions of real patient and financial transactions, we’ve achieved a 98% RPM payment success rate.
Keeps Your Data Safe and Secure
Built from the ground up to meet HIPAA standards, our solutions protect your sensitive information without sending it outside your control—peace of mind included.
Accurate Billing You Can Trust
Our technology ensures every claim is right the first time, cutting errors that lead to denials. No complicated AI gimmicks—just dependable results tailored for healthcare billing.
Affordable for Small Practices
FairPath skips the big setup fees and tech headaches. You get expert billing support customized to your needs, at a price that fits your budget.
Full Service Billing Assistance
Larger partners can integrate FairPath's platform for their own RCM needs, leveraging our proven technology.
Try FairPath Today

How Does FairPath Work? Try Our Low-Risk Starter  

Discover how FairPath processes your billing with a low-risk starter package:
  • Upload 1-3 claims
  • Let our AI handle eligibility, coding, and status checks
  • See 98% payment success, less than 5% denials, and 90% payments in 30 days in just 24-48 hours—no big fees
Since 2018, we’ve delivered precise results for practices like yours. Start exploring today!
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Our Solutions

Tailored AI for Healthcare

At Intelligence Factory, we harness cutting-edge AI to solve healthcare's toughest challenges. Our solutions streamline billing, enhance patient engagement, and ensure compliance, all powered by hallucination-free technology designed for your success.
FairPath
End-to-End Software Package
What It Is:
FairPath is a compliance-first platform that lets practices run their own remote care programs with audit-readiness. From onboarding, device management, and program management, to clinical reviews and patient communications, to billing and claims submission, FairPath has all the tools you need to run your RPM program.

Why It Matters:
FairPath aligns every claim with CMS rules, reducing fraud risk and denial rates. You stay compliant without adding tech staff or stress.
Learn More About FairPath →
FairPath Pro
Turnkey RPM Solution
What It Is:
A turnkey service where Intelligence Factory manages your full RPM program—staffing, onboarding, monitoring, billing, compliance.

Why It Matters:
You gain the benefits of remote care without learning Medicare billing rules or adding overhead. It’s plug-and-play RPM, built right.
Learn More About FairPath Pro →
Nurse Amy
Patient Engagement Agent
What It Is:
A virtual care agent that improves patient follow-through. Nurse Amy automates reminders, support calls, and satisfaction check-ins for RPM, RTM, and CCM patients.

Why It Matters:
Higher patient compliance means more billable events, better outcomes, and less staff burden. Amy keeps patients engaged automatically.
Learn More About Nurse Amy →
Buffaly + NLU
Ontology Engine with Integrated Language Engine
What It Is:
A medical-grade ontology engine that transforms messy notes and alerts into clean, structured billing and compliance data. Additionally, Buffaly allows for interoperability between disparate systems – ICD-10, CPT, SNOMED.

Why It Matters:
It solves messy data problems with precision, turning chaos into clear outputs that save time and boost accuracy.
Learn More About Buffaly NLU →
The intelligence factory difference

What makes
Intelligence Factory different?

Not all AI is created equal. In an era where everyone claims to be "AI-powered," thetechnology beneath the surface matters more than ever. We've spent nearly two decadesbuilding AI that doesn't just sound intelligent—it delivers reliable, transparent, andactionable results in environments where mistakes aren't acceptable.At Intelligence Factory, we harness cutting-edge AI to solve healthcare's toughest challenges. Our solutions streamline billing, enhance patient engagement, and ensure compliance, all powered by hallucination-free technology designed for your success.
Battle-tested acrossindustries for 16 years
Since 2009, we've been solvingcomplex problems with AI—intransportation systems, clinicalenvironments, aviation operations,supply chain monitoring, and beyond.This cross-industry experiencemeans our platform has been stress-tested against diverse requirements,from split-second logistics decisionsto life-critical healthcare protocols.We've weathered the entire evolutionof AI technology and emerged withsolutions that actually work in the realworld.
Not an LLM wrapper complete technical independence
The AI boom made access tolanguage models widespread, andwith it came a flood of 'AI solutions'that are really just promptengineering on top of ChatGPT orsimilar platforms. We'refundamentally different. Our entire AIstack is proprietary, built from theground up by our team. No promptengineering shortcuts. Nodependency on OpenAI, Google, orany third-party AI provider.
Explainable, auditable, hallucination free AI
Generic LLMs operate as black boxesthat generate plausible-sounding text—sometimes accurate, sometimesfabricated. Our Buffaly OntologyEngine takes a fundamentallydifferent approach using OGAR(Ontology-Guided AugmentedRetrieval): structured domainknowledge that the AI navigates withprecision rather than statisticalpattern matching.
This gives you:
Data sovereignty
Your proprietary information never leaves your infrastructure ortouches external AI services

Security assurance
No exposure to third-party vulnerabilities, policy changes, orservice outages

Performance optimization
Technology tuned to your specific domain, not trained on generalinternet knowledge

Future-proof architecture
You're not locked into someone else's technology roadmap orpricing model
The practical difference:
Zero hallucinations
The system can only draw from your curated, validatedknowledge base

Complete transparency
Every output includes the reasoning and sources behind it

Regulatory compliance
Audit trails and documentation that satisfy even the strictestrequirements

Expert control
Your domain specialists define what the AI knows and how itapplies that knowledge
When your teams can trace exactly how the AI reached each conclusion, adoption acceleratesand trust builds naturally.
Compliance Without Complexity

The Five Pillars of a Compliant, Scalable RPM Program

FairPath directly addresses the issues highlighted in the OIG’s 2024 RPM audit—preventing fraud, missed revenue, and denials.
Consolidated Data Platform
Unified dashboard for all device data

AI flags urgent readings

No more portal-hopping or missed interventions
Billing & Charge Optimization
Fully automates 99453, 99454, and 99457/99458 billing

Calibrates charges to avoid payer scrutiny

Flags duplicates and multi-episode risks
Compliance & Documentation Engine
Timestamps every interaction in a HIPAA-compliant system

Tracks who did what, when

Proven to defend audits and clawbacks
Patient Engagement Tools
30% improvement in usage from calls/texts

Captures 99453 consent and education digitally

Flags inactive patients before it’s too late
Eligibility Verification System
Real-time checks for Medicare, Advantage, and dual plans

Flags ineligible patients pre-enrollment

Prevents non-reimbursable claims and wasted setups
Portfolio Highlights

Structured Solutions for Remote Care

Each of these projects reflects the same principles behind FairPath: structured AI, built for trust, transparency, and real-world complexity. From scalable eligibility checks to seamless EHR integration, these solutions show how our technology performs under pressure—exactly where it counts.
Turn Medical Chaos into Structured Insight
Seamlessly unify fragmented EHR and EMR data with a semantic engine designed for healthcare.
FairPath’s integration layer normalizes inputs from over 30 EHR systems—including Epic and eClinicalWorks—transforming disconnected diagnoses, labs, and billing codes into one coherent data model that powers eligibility checks, reporting, and automation.
Learn More →
Allocate Clinical Time Without Compromising Care
After critical alerts, every patient still deserves attention—but time is finite.
FairPath uses adaptive algorithms to help clinicians decide who to engage next—balancing need, compliance, and sustainability. It’s not about cutting corners; it’s about using every minute wisely to maximize real patient impact.
Learn More →
Eligibility Without the Guesswork—or the Per-Transaction Fees
Automated coverage checks built for practices that can’t afford enterprise systems.
With FairPath, eligibility validation is no longer a bottleneck. Our ontology-driven engine delivers high-accuracy checks across insurers and program types—fully auditable and designed for underserved providers.
Learn More →
Beyond Healthcare

Our Artificial Intelligence Legacy

While healthcare is our focus, Intelligence Factory's AI has a proven track record across industries. Our Feeding Frenzy suite has optimized sales and support workflows for IT companies, showcasing our technology's versatility and reliability beyond medical billing.
Learn About Non-Medical
Solutions →
How It Works

A Simplified, AI-Driven Billing Workflow

Our AI solution transforms your billing process with a structured, step-by-step approach:
The image depicts a stylized clipboard icon with bold purple outlines and orange highlights, including checkmarks and horizontal lines representing text fields or entries. It conveys the process of claim preparation and submission, symbolizing tasks like filling out forms, verifying details, or preparing documents for submission in a structured and organized manner. The use of checkmarks emphasizes completion or readiness.
Eligibility Verification
Instantly confirm patient coverage with AI that retrieves accurate, real-time insurance details.
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Claims Coding
Generate precise CPT codes and ICD-10 mappings to prevent denials and resubmissions.
The image represents eligibility verification. The profile card with a person icon symbolizes individual data or identity, while the magnifying glass emphasizes the process of closely examining or verifying details. The connecting nodes suggest a system or network approach, indicating the process of assessing eligibility within a structured or interconnected framework, likely involving data evaluation and confirmation.
Prior Authorization
Skip the manual process—our AI gathers required information and expedites approvals.
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Seamless Integration
Easily connect with your EHR, practice management systems, and billing software through scalable APIs.

Take the First Step with Intelligence Factory

Ready to transform your billing process? Whether you're a small practice seeking our expert billing service or a larger partner looking to integrate FairPath's technology, we're here to help you succeed.

Call us at (689) 600-1779
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Recent Updates

CMS’s 2026 Updates Signal a New Era for In-House Remote Care Coordination

Healthcare is on the brink of a fundamental shift. The forthcoming 2026 CMS Physician Fee Schedule updates are far more significant than mere billing adjustments, they signal a new era in remote care coordination. Practices that adapt early will not only enhance patient care but also secure long-term operational advantages.

While Remote Patient Monitoring (RPM) has rightly captured attention, RPM alone is only part of a larger, more transformative opportunity: comprehensive, integrated remote care coordination. The CMS 2026 updates represent an ideal moment for healthcare leaders to internalize these capabilities and build robust, patient-centered remote care strategies.

What's Changing with CMS in 2026?

The upcoming CMS changes (finalized November 2025, effective January 1, 2026) reshape the operational landscape for remote healthcare:

  • Flexible Monitoring Requirements: New CPT codes (e.g., 99XX4) now cover patient monitoring for as little as 2–15 days, eliminating previous barriers linked to the 16-day minimum requirement.

  • Shorter Interaction Thresholds: The introduction of CPT code 99XX5 (10–19 minutes of interaction) better aligns with real-world clinical workflows, supplementing the existing 20-minute engagement standards.

  • Permanent Virtual Supervision: Physicians can now permanently supervise clinical teams remotely via audio-video technology, making it possible to centralize staffing and streamline operations.

  • Revised Valuation Model: A transition to Outpatient Prospective Payment System (OPPS)-based valuations ensures reimbursements accurately reflect operational realities.

Together, these adjustments significantly improve feasibility and profitability for in-house remote care coordination.

Building Your Comprehensive Remote Care Ecosystem

To maximize these new guidelines, practices must think beyond RPM alone and adopt a broader vision of integrated remote care. Leaders should consider including:

  • Remote Therapeutic Monitoring (RTM): For therapy adherence, medication compliance, and behavioral health support.

  • Chronic Care Management (CCM): Providing continuous, proactive management of chronic conditions.

  • Transitional Care Management (TCM): Ensuring smooth post-hospitalization transitions to reduce readmission risks.

  • Advanced Primary Care Management (APCM): Facilitating proactive, comprehensive care tailored to value-based primary care frameworks.

  • Primary Care Management (PCM): Targeted management for patients with specific chronic conditions, enhancing quality and engagement.

By integrating these programs, practices will foster a more comprehensive remote care environment that improves patient satisfaction, clinical outcomes, and operational efficiencies.

Why Now Is the Ideal Moment for In-House Implementation

Historically, practices have hesitated to implement remote care internally due to complexity and resource constraints. However, modern platforms such as FairPath have dramatically simplified the operational landscape. Now practices can manage patient enrollment, interactions, documentation, and billing through a single intuitive system.

The advantages of bringing these programs in-house are compelling:

  • Enhanced Revenue Control: Minimize third-party expenses and retain more revenue within your practice.

  • Customized Patient Experiences: Tailor workflows specifically to your patient population, rather than relying on generic external solutions.

  • Operational Scalability: Leverage virtual supervision to streamline staffing, optimize overhead costs, and expand operational capacity.

  • Streamlined Compliance: Automated tracking and reporting facilitate effortless compliance with evolving CMS regulations.

Action Steps for Forward-Thinking Practices

To fully leverage CMS’s 2026 updates, healthcare leaders should begin preparations now:

  • Assess Patient Eligibility: Determine patient cohorts eligible for RPM, CCM, RTM, TCM, APCM, and PCM under the new CMS standards.

  • Consolidate Technology Platforms: Adopt unified software solutions that integrate all remote care services into one user-friendly environment.

  • Establish Robust Virtual Oversight: Develop and implement standardized virtual supervision protocols to ensure consistency and quality across your remote care programs.

  • Conduct Targeted Staff Training: Train clinical teams to effectively manage shorter, frequent patient interactions aligned with the new CPT codes.

  • Launch Early and Iterate Quickly: Start operations on January 1, 2026, and continuously refine workflows based on real-world feedback and performance data.

Guardrails to Avoid Common Pitfalls

As your practice transitions to comprehensive remote care coordination, stay vigilant about common pitfalls:

  • Avoid technology fragmentation by committing to unified, scalable platforms.

  • Clearly define roles within virtual supervision models to prevent ambiguity and compliance risks.

  • Ensure accurate and timely documentation—particularly critical with shorter interaction windows—to maintain compliance and optimize reimbursement.

  • Regularly audit workflows to identify inefficiencies or compliance vulnerabilities early.

Embrace the Opportunity of Comprehensive Remote Care

The CMS 2026 updates are more than a regulatory adjustment—they are a gateway to comprehensive, integrated remote care. RPM will continue to be a crucial component, but practices that expand their vision to integrate CCM, RTM, TCM, APCM, and PCM will reap the greatest rewards.

Healthcare leaders who act decisively now will set the standard for future patient care, positioning their organizations for long-term clinical, operational, and financial success.

Ready to explore how these CMS changes can transform your practice? Reach out right now and we will set up a complimentary strategy session and start building your integrated remote care solution.

Disclaimer: This article is informational only; specific rates and policies vary by MAC and payer plan.

CMS Brings Behavioral Health into the APCM Model: What It Means for Primary Care

The opportunity and the risk


CMS is quietly reshaping how primary care teams can be paid for mental and emotional health support. Starting in 2026 (if finalized), practices using the new Advanced Primary Care Management (APCM) codes will be able to add small, monthly payments for behavioral health integration. It’s a major shift that rewards clinics for treating the whole person, not just physical symptoms. The risk is missing the operational readiness window: teams that wait until 2026 to understand the new codes will find themselves scrambling to align workflows and documentation.

A new layer in primary care payment


For years, CMS has talked about whole-person care, but reimbursement never fully caught up. The APCM model is changing that. If finalized, practices that already bill the new APCM care codes can tack on additional payments when their care includes mental health or substance-use management. In practical terms, it’s like saying: if you’re already managing a patient’s chronic conditions, and part of that care includes depression screening, counseling coordination, or medication oversight, CMS will pay you a little more for that extra work.

These new payments come through three add-on codes: GPCM1, GPCM2, and GPCM3. Each one ties to a real-world activity clinics already do but haven’t been fully reimbursed for.

The three behavioral health add-on codes in action


GPCM1 covers the first month of behavioral health integration. This includes identifying a mental health need, discussing options with the patient, and coordinating with a specialist. For example, a family doctor might screen for depression, develop an action plan, and consult with a psychiatrist about medication choices.

GPCM2 supports ongoing follow-up months. The clinic continues the plan, checks progress, and adjusts medications or referrals. Think of a nurse checking in weekly with the patient, tracking symptoms, and updating the psychiatrist as needed.

GPCM3 recognizes general behavioral health management directly within primary care. This applies when clinics provide counseling, medication monitoring, or mental health support without bringing in a psychiatrist. For instance, a nurse might help a patient manage anxiety symptoms and report progress to the doctor.

Clinics can only use these codes as add-ons to a monthly APCM claim. They’re optional but designed to fit naturally into what many primary care teams already do for patients with depression, anxiety, or substance-use conditions.

Why CMS is expanding behavioral health within APCM


The logic behind this change is straightforward: physical and mental health are deeply connected. Patients managing diabetes, heart disease, or chronic pain often struggle more when depression or anxiety go untreated. CMS wants to encourage clinics to address both at once, instead of sending patients elsewhere or letting mental health needs slip through the cracks.

This new approach does three key things:

It expands access. Clinics in rural and underserved areas, especially Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), will be able to bill for these services, bringing behavioral health support to communities where specialists are limited.

It reduces administrative friction. These new codes replace older behavioral health integration codes that required precise time tracking in minutes. The simplified structure means less paperwork and clearer billing for chronic and behavioral care that happens together.

It rewards realistic team-based care. Practices won’t need to overhaul systems or hire new staff to qualify. They can layer these add-ons on top of existing care management routines, using the same nurses, care coordinators, and medical assistants already involved in APCM activities.

What still needs clarification


As with any CMS update, the fine print isn’t final. The agency is still collecting feedback before it locks in the 2026 rule. Several operational details are open for comment, including how closely a psychiatrist or psychologist must supervise behavioral health activities, which care team roles are eligible to contribute, and how patient cost-sharing will be handled.

It’s also unclear whether these new APCM behavioral codes can be billed in the same month as the older behavioral health integration codes (99492–99494). CMS may require practices to choose one pathway to prevent double billing. Until the rule is finalized, practices should stay conservative in their planning and assume mutual exclusivity between the two sets of codes.

How practices can start preparing now


Forward-thinking clinics can take several steps in advance of 2026 to avoid being caught off guard. The most successful adopters will likely focus on three areas:

First, align clinical workflows. Map how behavioral health activities already show up in your APCM care process. Identify where screenings, follow-ups, or care coordination occur and who documents them. That clarity will make it easy to plug in the new codes when they’re approved.

Second, strengthen collaboration with mental health partners. If your practice occasionally refers to a psychiatrist, psychologist, or counselor, consider formalizing those relationships now. Shared templates, communication channels, and role clarity will make the transition smoother and compliant.

Third, get your billing and compliance teams ready. Talk to your EHR vendor and billing staff about upcoming APCM add-on logic. Make sure your documentation templates are flexible enough to capture behavioral health interventions without adding burden.

The compliance guardrails to keep in mind


Every new code introduces compliance risk if documentation doesn’t match the intent. Practices should be cautious about double counting services, overstating mental health involvement, or billing when behavioral health support wasn’t clearly provided. The safest approach is to document exactly what occurred that month: what mental health issue was addressed, who participated, what plan was made, and whether the patient agreed to ongoing monitoring.

It’s also important to remember that CMS still expects appropriate supervision for team-based activities. Even if direct psychiatrist oversight isn’t always required, the clinical documentation should show coordination and shared accountability. That’s especially critical for risk-bearing organizations or practices participating in value-based arrangements where behavioral health outcomes tie to performance metrics.

Why this matters for the future of primary care


This move from CMS signals a broader recognition that behavioral health can’t be treated as an add-on service. It’s a core part of whole-person care and, increasingly, of how primary care practices will be paid. If finalized, the APCM behavioral health add-ons could finally bridge the gap between chronic disease management and mental health treatment in everyday practice.

Early modeling suggests the financial impact won’t be massive per patient, but it can add up meaningfully across a large panel. More importantly, it gives clinics a practical framework to treat depression, anxiety, or substance-use issues as part of routine primary care—without needing to navigate multiple disconnected programs.

For leaders building sustainable primary care models, this is a moment worth watching closely. The clinics that prepare now—clinically, operationally, and financially—will be ready to take advantage of the shift when it becomes real.

Next steps


If your organization wants a clear roadmap for integrating behavioral health within APCM, request a 45-minute readiness review. We’ll walk through your current care management processes, identify where behavioral health naturally fits, and outline what preparation is worth doing before 2026.

This post is for informational purposes only; specific billing rules and reimbursement rates vary by MAC and payer.

Stop Choosing Between APCM and Your RPM/RTM Revenue

The $1.2 Million Mistake Most Practices Are Making Right Now

If your practice adopted APCM by shutting down RPM and RTM programs, you left money on the table. If you're running all three programs separately, you're burning cash on duplicate documentation and exposing yourself to compliance risk.

The correct answer isn't either-or, its coordinated integration. Practices that get this right are generating $225-325 net margin per patient monthly while reducing administrative burden by up to 30%.

Here's how the economics actually work, and what separates winning practices from everyone else.

Why Practices Get This Wrong

CMS introduced APCM as a structural upgrade to care management, not a replacement for monitoring programs. Yet most practices treat it as one:

The Replacement Trap: Practices abandon profitable RPM and RTM programs, assuming APCM covers everything. It doesn't. You lose monitoring revenue and weaken care continuity.

The Silo Trap: Practices run all three programs independently, creating redundant workflows, conflicting documentation, and billing errors that invite audits.

Both approaches cost you money. The first sacrifices revenue. The second burns it on overhead.

The Integration Model: Three Programs, One System

Successful practices recognize that APCM, RPM, and RTM serve distinct clinical and financial functions:

APCM provides the overall care management structure—provider accountability, care planning, and transition management.

RPM and RTM deliver continuous patient data that drives specific interventions within that structure.

Integration means these programs share one care plan, one documentation system, and one accountability framework. You bill separately for each service, but you execute them as a unified operation.

What This Looks Like Operationally

Single Care Plan: RPM glucose readings or RTM therapy adherence data flow directly into the APCM care plan, triggering interventions automatically.

Unified Task Management: All outreach, education, and monitoring tasks appear on one centralized list—not scattered across three platforms.

Automated Documentation: Software captures activity in real time, meeting all program-specific billing requirements without duplicate data entry.

One Accountability System: Care navigators, nurses, and providers coordinate under a single supervisory framework rather than juggling separate program rules.

This eliminates the false trade-off between patient volume and compliance. Practices scale both simultaneously.

The Financial Case: Real Numbers from In-House Programs

Most practices running siloed programs capture $150-180 per patient monthly across RPM or basic care management. They're leaving significant reimbursement unclaimed.

Integrated in-house APCM + RPM + RTM programs using modern automation generate $250-350 per patient per month in combined reimbursement. Program costs run approximately $25 per patient monthly ($10 software, $15 per device rental).

Net margin per patient: $225-325 per month, depending on complexity and time documented.

Staffing efficiency compounds these gains. In siloed programs, a three-person care team (two RNs, one MA) manages 600-700 patients due to documentation overhead and system friction. Integrated systems with automation enable the same team to handle 900-1,000 patients while maintaining compliance.

The financial impact is substantial:

Traditional siloed model:

  • 700 patients × $160/month = $112,000 monthly gross revenue
  • Higher admin overhead, fragmented workflows
  • Est. 40% margin after labor and overhead = $44,800 monthly profit

Integrated in-house model:

  • 950 patients × $290/month = $275,500 monthly gross revenue
  • ~$25/patient program costs = $23,750 monthly
  • Same care team, 25% less admin time
  • Est. 55% margin after all costs = $151,525 monthly profit

That's a $106,725 monthly difference, or $1.28 million annually, with identical headcount.

These figures reflect actual CMS reimbursement rates and reported results from practices running integrated programs in 2024-2025. The difference comes from eliminating waste and capturing all available compliant reimbursement—not from aggressive billing.


Clinical Scenarios Where Integration Drives Value

Chronic Disease Management (RPM + APCM)

A diabetes patient's RPM glucose monitor flags elevated readings. In an integrated system, those readings automatically update the APCM care plan and trigger an intervention protocol. One documentation event satisfies both programs' billing requirements.

Post-Surgical Rehabilitation (RTM + APCM)

A patient recovering from knee surgery stops engaging with home therapy exercises tracked through RTM. Integrated software alerts the APCM care team immediately, enabling intervention before outcomes deteriorate. Both programs bill compliantly from the same workflow.

Complex Post-Hospitalization Care (RPM + RTM + APCM)

A COPD patient discharged from the hospital needs breathing monitoring (RPM), therapy adherence tracking (RTM), and transition management (APCM). All three run from one system, preventing readmission while maximizing compliant reimbursement.

In each case, integration creates clinical value and financial value simultaneously—not by gaming the system, but by eliminating waste.


Compliance: The Four Non-Negotiables

Integration increases revenue only if you maintain clear program separation in documentation and billing:

Differentiate Services Clearly: Document what RPM, RTM, and APCM each provide. Never blur the lines.

Prevent Time Overlap: If you bill 20 minutes for APCM, that same 20 minutes cannot count toward RPM time requirements.

Document Care Transitions: APCM requires thorough transition documentation. Automate this wherever possible, but verify completeness.

Audit Monthly: Run internal reviews to catch billing errors before external audits do.

Automation handles most of this oversight, but governance remains essential. The practices that avoid trouble treat compliance as a system design problem, not a documentation problem.


Why Automation Is Non-Negotiable

Integration without automation is theory. Automation makes it operational reality.

Platforms like FairPath centralize patient records, automatically manage care tasks against billing criteria, and generate audit-ready documentation in real time. This isn't about convenience—it's about making integration financially viable.

Without automation, the administrative load of running three coordinated programs exceeds the efficiency gains. With automation, you unlock the full revenue potential while reducing overhead.


What to Do Next

If you're running APCM, RPM, or RTM in isolation, you're likely generating $150-180 per patient monthly—and leaving $100-170 per patient unclaimed. If you're avoiding APCM because you think it conflicts with existing programs, you're missing a seven-figure annual opportunity.

The strategic question isn't whether to integrate. It's how quickly you can operationalize integration with the right automation and cost structure to capture $225-325 net margin per patient.

Do This Next:

  1. Audit your current APCM, RPM, and RTM programs separately—identify overlap, gaps, and billing inefficiencies
  2. Calculate your current per-patient monthly net margin across all programs (including software and device costs)
  3. Model the revenue impact of full integration using the $225-325 net margin per patient benchmark and your current census
  4. Evaluate whether your current software can support unified workflows or if you need a purpose-built platform
  5. Schedule a 45-minute APCM Integration Review to map your specific opportunity and compliance requirements

Integration isn't the future of care management—it's the present. The only question is whether you'll capture the opportunity this year or watch competitors do it first.

Disclaimer: This article provides general information only. Specific reimbursement rules and eligibility vary by MAC, payer, and contract year. Consult with compliance and billing specialists before implementing new programs.

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Noncompete Clauses In Healthcare: The FTC Warning, APCM Staffing, And Platform Partnerships

9/16/25

The Federal Trade Commission’s Sept. 12 warning to healthcare employers is a simple message with real operational consequences. Overbroad noncompetes, no‑poach language, and “de facto” restraints chill worker mobility and can limit patients’ ability to choose their clinicians. For practices building Advanced Primary Care Management teams, restrictive templates do more than create legal risk...

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The APCM Quick Start Guide: Converting Medicare's Complex Care Program Into Practice Growth

9/9/25

Advanced Primary Care Management represents Medicare's most ambitious attempt to transform primary care economics. Unlike previous programs that nibbled at the margins, APCM fundamentally restructures how practices organize, deliver, and bill for comprehensive care...

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13 Things You Need To Implement Advanced Primary Care Management (APCM)

9/5/25

Advanced Primary Care Management (APCM) is Medicare’s newest program, introduced in 2025 with three billing codes: G0556, G0557, and G0558. This represents a pivotal shift toward value-based primary care by offering monthly reimbursements for delivering continuous, patient-focused services. You're already providing these services—why not get paid for it?

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When Women's Health Can't Wait: How Remote Care Creates Presence in Life's Most Critical Moments

8/26/25

At 2 AM, a new mother in rural Alabama feels her heart racing. She's two weeks postpartum, alone with a newborn while her husband works the night shift. Her blood pressure reading on the home monitor shows 158/95. Within minutes, her care team receives an alert. By 6 AM, a nurse has called, medications are adjusted, and what could have been a stroke becomes a story of crisis averted.

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Medical Remote Care: How Vendor Models Shift Margin and When to Bring RPM In-House

8/18/25

Many health systems pay full-service RPM vendors $40–$80 PMPM for services they can in-source for far less. With 2025 Medicare rates and OIG scrutiny, it's time to revisit the build-vs-buy math.

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Why 73% of Practices Still Fear Remote Care and How the Winning 27% Think Differently

8/11/25

A few months ago, a physician at a 12-doctor practice in rural California called me frustrated. His practice was hemorrhaging money on readmissions, his nurses were burning out from phone tag with chronic disease patients, and his administrator was getting pressure from...

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Reclaiming Revenue: How Smart Medical Executives Are Transforming Remote Care into Sustainable Profit Centers

8/6/25

Medical executives today face an uncomfortable reality: while navigating shrinking margins and mounting operational pressures, many are unknowingly surrendering millions in Medicare reimbursements to third-party vendors. The culprit? Poorly structured Remote Patient Monitoring (RPM), Chronic Care Management (CCM)...

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RPM’s $16.9B Gold Rush: Why 88% of Claims Skip CMS Review (And How Industry Leaders Are Responding)

7/23/25

Remote Patient Monitoring (RPM) has rapidly evolved from emerging healthcare innovation into a strategic necessity. Driven aggressively by CMS reimbursement policies, RPM adoption has accelerated at unprecedented rates...

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Medicare's $4.5 Billion Wake-Up Call: What the VBID Sunset Reveals About Risk, Equity, and the Next Era of Value

7/17/25

In a single December blog post, CMS just rewrote the playbook for $400 billion in annual Medicare Advantage spending. The termination of the Medicare Advantage Value-Based Insurance Design...

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Why the AMA’s 2026 RPM Changes Are Exactly What Your Practice Needs

7/8/25

If you've spent any time managing a remote patient monitoring (RPM) program, you already know the drill: juggling the 16-day rule, keeping track of clinical minutes, chasing compliance, and often wondering if this is really what patient-centered care was meant to feel like...

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Healthcare Needs a Group Chat, And Digital Twins Are the Invite

7/1/25

Let’s be honest. Managing your health today feels like trying to coordinate a group project where nobody checks their messages. Your cardiologist, endocrinologist...

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The Great Code Shift: Turning the ICD-11 Mandate into a Competitive Advantage

6/25/25

The healthcare industry still has scars from the ICD-9 to ICD-10 transition. The stories are legendary in Health IT circles: coder productivity plummeting, claim denials surging, and revenue cycles seizing up for months. It was a painful lesson in underestimation...

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Beyond the Box: Finding the Signal in RPM's Next Chapter

6/19/25

In my work with healthcare organizations across the country, I see two distinct patient profiles coming into focus. They represent the past and future of remote care, and every successful practice must now build a bridge between them...

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The Living Echo: How Digital Twins Are Reshaping Personalized Healthcare and Operational Excellence

6/11/25

The healthcare landscape is continuously evolving, and among the most profound shifts emerging is the concept of the Digital Twin for Patients. This technology isn't merely an abstract idea...

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Why the MIPS MVP Model is the Future—and How Your Practice Can Win

6/2/25

Change is inevitable in healthcare. Often, it feels overwhelming—but occasionally, a new shift arrives that genuinely makes things simpler...

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Does RPM Miss What Patients Really Need?

5/27/25

It starts with a data spike… a sudden drop in movement, a rise in reported pain. The alert pings the provider dashboard, hinting at deterioration. But what if that signal isn’t telling the whole truth

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Transforming Chronic Pain: The Power of RPM, RTM, and CCM

5/19/25

Chronic pain isn’t just a condition, it’s a thief. It steals time, joy, and freedom from over 51 million Americans, according to the CDC, costing the economy $560 billion a year. As someone passionate about healthcare innovation, I’ve seen how this silent struggle affects patients, families, and providers...

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Introduction: Demystifying Ontology—Returning to the Roots

5/16/25

In the tech industry today, we frequently toss around sophisticated terms like "ontology", often treating them like magic words that instantly confer depth and meaning. Product managers, software engineers, data scientists—everyone seems eager to invoke..

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APCM Codes: The Quiet Revolution in Primary Care

5/13/25

Picture Mary, 62, balancing a job and early diabetes. Her doctor, Dr. Patel, is her anchor—reviewing labs, coordinating with a nutritionist, tweaking her care plan. But until 2025, Dr. Patel wasn’t paid for this invisible work...

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It Always Starts Small: Lessons from the Front Lines of Healthcare Audits

4/28/25

In healthcare, most of the time, trouble doesn't announce itself with sirens and red flags. It starts quietly. A free dinner here. A paid talk there. An event that feels more like networking than education...

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Unveiling RPM Fraud Risks—A Technical Dive into OIG Findings and FairPath’s AI Fix

4/24/25

The Office of Inspector General’s (OIG) 2024 report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), isn't just an alert—it's a detailed playbook exposing critical vulnerabilities in Medicare’s Remote Patient Monitoring (RPM) system...

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The Cost of Shortcuts: Lessons From a $4.9 Million Mistake

4/21/25

When the Department of Justice announces settlements, many of us glance at the headlines and move on. Yet, behind those headlines are real stories about real decisions...

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One Biller, One Gap: How a Missing Piece Reshapes Everything

4/14/25

There’s a quiet agreement most of us make in business. It’s not in a contract. It’s not written on a whiteboard. But it runs everything: trust...

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The System Is Rigged: How AI Helps Independent Docs Fight Back

4/10/25

Feeling like you’re drowning in regulations designed by giants, for giants? If you're running a small practice in today's healthcare hellscape, it damn sure feels that way...

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Trust Is the Real Technology: A Lesson in Healthcare Partnerships

4/7/25

When people ask me what Intelligence Factory does, they often expect to hear about AI, automation, or billing systems. And while we do all those things...

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Million Dollar Surprise

4/3/25

“They’re going to put me out of business. They want over a million dollars. I don’t have a million dollars”, his voice cracked over the phone...

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Unlocking AI: A Practical Guide for IT Companies Ready to Make the Leap

12/22/24

Introduction: The AI Revolution is Here—Are You Ready?

Artificial intelligence isn’t just a buzzword anymore—it’s a transformative force reshaping industries worldwide. Yet for many IT companies, the question isn’t whether to adopt AI but how...

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Agentic RAG: Separating Hype from Reality

12/18/24

Agentic AI is rapidly gaining traction as a transformative technology with the potential to revolutionize how we interact with and utilize artificial intelligence. Unlike traditional AI systems that passively respond to...

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From Black Boxes to Clarity: Buffaly's Transparent AI Framework

11/27/24

Large Language Models (LLMs) have ushered in a new era of artificial intelligence, enabling systems to generate human-like text and engage in complex conversations...

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Bridging the Gap Between Language and Action: How Buffaly is Revolutionizing AI

11/26/24

The rapid advancement of Large Language Models (LLMs) has brought remarkable progress in natural language processing, empowering AI systems to understand and generate text with unprecedented fluency. Yet, these systems face...

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When Retrieval Augmented Generation (RAG) Fails

11/25/24

Retrieval Augmented Generation (RAG) sounds like a dream come true for anyone working with AI language models. The idea is simple: enhance models like ChatGPT with external data so...

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SemDB: Solving the Challenges of Graph RAG

11/21/24

In the beginning there was keyword search. Eventually word embeddings came along and we got Vector Databases and Retrieval Augmented...

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Metagraphs and Hypergraphs with ProtoScript and Buffaly

11/20/24

In Volodymyr Pavlyshyn's article, the concepts of Metagraphs and Hypergraphs are explored as a transformative framework for developing relational models in AI agents’ memory systems...

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Chunking Strategies for Retrieval-Augmented Generation (RAG): A Deep Dive into SemDB’s Approach

11/19/24

In the ever-evolving landscape of AI and natural language processing, Retrieval-Augmented Generation (RAG) has emerged as a cornerstone technology...

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Is Your AI a Toy or a Tool? Here’s How to Tell (And Why It Matters)

11/7/24

As artificial intelligence (AI) becomes a powerful part of our daily lives, it’s amazing to see how many directions the technology is taking. From creative tools to customer service automation...

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Stop Going Solo: Why Tech Founders Need a Business-Savvy Co-Founder (And How to Find Yours)

10/24/24

Hey everyone, Justin Brochetti here, Co-founder of Intelligence Factory. We're all about building cutting-edge AI solutions, but I'm not here to talk about that today. Instead, I want to share...

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Why OGAR is the Future of AI-Driven Data Retrieval

9/26/24

When it comes to data retrieval, most organizations today are exploring AI-driven solutions like Retrieval-Augmented Generation (RAG) paired with Large Language Models (LLM)...

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The AI Mirage: How Broken Systems Are Undermining the Future of Business Innovation

9/18/24

Artificial Intelligence. Just say the words, and you can almost hear the hum of futuristic possibilities—robots making decisions, algorithms mastering productivity, and businesses leaping toward unparalleled efficiency...

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A Sales Manager’s Perspective on AI: Boosting Efficiency and Saving Time

8/14/24

As a Sales Manager, my mission is to drive revenue, nurture customer relationships, and ensure my team reaches their goals. AI has emerged as a powerful ally in this mission...

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Prioritizing Patients for Clinical Monitoring Through Exploration

7/1/24

RPM (Remote Patient Monitoring) CPT codes are a way for healthcare providers to get reimbursed for monitoring patients' health remotely using digital devices...

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10X Your Outbound Sales Productivity with Intelligence Factory's AI for Twilio: A VP of Sales Perspective

6/28/24

As VP of Sales, I'm constantly on the lookout for ways to empower my team and maximize their productivity. In today's competitive B2B landscape, every interaction counts...

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Practical Application of AI in Business

6/24/24

In the rapidly evolving tech landscape, the excitement around AI is palpable. But beyond the hype, practical application is where true value lies...

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AI: What the Heck is Going On?

6/19/24

We all grew up with movies of AI and it always seemed to be decades off. Then ChatGPT was announced and suddenly it's everywhere...

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Paper Review: Compression Represents Intelligence Linearly

4/23/24

This is post is the latest in a series where we review a recent paper and try to pull out the salient points. I will attempt to explain the premise...

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SQL for JSON

4/22/24

Everything old is new again. A few years back, the world was on fire with key-value storage systems. I think it was Google's introduction of MapReduce that set the fire...

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Telemedicine App Ends Gender Preference Issues with AWS Powered AI

4/19/24

AWS machine learning enhances MEDEK telemedicine solution to ease gender bias for sensitive online doctor visits...

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