You're Leaving $73K-$468K on the Table Every Year
Small primary care practices miss AWV, CCM, and TCM revenue because documentation is too burdensome without a billing optimization team. Capture revenue without the burden. Leave work on time while optimizing Medicare billing automatically.
Built for Small Independent Practices That Enterprise Solutions Overlook
Independent practices (2-20 providers) without revenue cycle management teams need automated Medicare billing capture. No billing optimization specialist required ($45K-$65K annually saved vs hiring).
Primary Care Practices Know These Lost Opportunities
Missed AWV Revenue
$25K-$50K annually in uncaptured wellness visits
TCM Overlooked
Hospital discharges without transition billing, $8K-$20K lost
CCM Time Tracking
Chronic care management too burdensome, $30K-$60K lost
Screening Opportunities
Depression and SDOH not systematically captured, $5K-$15K lost
6 Medicare Programs Supported
Automated workflows for AWV, CCM, TCM, RPM, BHI, and Advance Care Planning
AWV Detection
Auto-alerts when patient qualifies for Annual Wellness Visit
TCM Automation
Hospital discharge triggers transition care management workflow
CCM Time Tracking
Automatic aggregation of qualifying care coordination minutes
BHI Integration
PHQ-9 triggers Behavioral Health Integration billing workflow
Pre-Filled Forms
Medicare forms auto-populated from documentation
Revenue Intelligence
Cross-visit analysis finds billing opportunities
Success Patterns from Primary Care Practices
Primary Care 2-5 Providers
Practices with high Medicare volume report capturing revenue previously left on the table.
- Save 2+ hours daily with automated AWV documentation
- $73K-$135K total Medicare opportunity captured annually
- Leave office by 6pm while optimizing billing
Geriatric-Focused Practices
Practices serving elderly populations with multiple chronic conditions report significant CCM revenue.
- $48K-$120K CCM revenue per 100-patient panel annually
- Automated time tracking reaches 20-minute monthly threshold
- Zero evening charting for care coordination documentation
Rural Practices with High Medicare Volume
Rural practices serving Medicare populations report capturing TCM and AWV revenue systematically.
- $15K-$45K TCM revenue from hospital discharge tracking
- $25K-$148K AWV opportunity with automated patient alerts
- No billing specialist needed vs $45K-$65K annual hire
Medicare Revenue Impact by Program
Streamlined Medicare Billing Workflows
AWV Capture
- 1. Patient turns 65 or annual visit window opens
- 2. System alerts provider of qualification
- 3. Schedule Annual Wellness Visit appointment
- 4. Complete comprehensive assessment during visit
- 5. Capture $174 revenue automatically
TCM Billing
- 1. Patient discharged from hospital
- 2. Trigger 7-14 day follow-up workflow
- 3. Complete post-discharge visit and medication reconciliation
- 4. Auto-document TCM requirements with timestamps
- 5. Bill $167-$239 per transition
CCM Revenue
- 1. Identify patient with 2+ chronic conditions
- 2. Track care coordination time automatically
- 3. Reach 20-minute monthly threshold
- 4. Generate comprehensive care plan from visits
- 5. Bill $40-$100 per patient monthly
Total Medicare Revenue Opportunity
Annual Wellness Visits
Auto-triggers eligible patients
Chronic Care Management
Per 100-patient panel annually
Transitional Care Management
Hospital discharge tracking annually
Total Annual Opportunity: $223K-$468K
For typical primary care practice across all 6 Medicare programs
Revenue Opportunity by Practice Size
Annual Medicare revenue potential across AWV, CCM, TCM, and BHI programs
Small Practice (2-5 Providers)
3,000-6,000 Medicare patients
Total Annual Opportunity:
$73K-$135K
Mid-Size Practice (5-10 Providers)
6,000-12,000 Medicare patients
Total Annual Opportunity:
$145K-$275K
Large Practice (10-20 Providers)
12,000-24,000 Medicare patients
Total Annual Opportunity:
$260K-$468K
Industry Reality Check:
Most primary care practices capture only 15-25% of this revenue potential due to documentation burden and workflow complexity. The remainder is left on the table annually.
Why Medicare Revenue Gets Left on the Table
The barriers preventing revenue capture in primary care
Documentation Burden
The Problem:
AWV requires 10+ elements, TCM needs timestamped communications, CCM demands 20-minute monthly tracking. Without automation, providers skip these services.
Impact:
$25K-$148K in AWV revenue alone left uncaptured annually
Workflow Complexity
The Problem:
Identifying eligible patients, triggering workflows, tracking time across visits, and completing required forms is too complex for busy practices without billing teams.
Impact:
$48K-$120K in CCM revenue missed due to inability to track 20-minute monthly threshold
Lack of Revenue Intelligence
The Problem:
Small practices don't have billing optimization specialists to identify opportunities. They focus on E/M codes and miss value-based programs.
Impact:
$15K-$45K in TCM revenue overlooked after hospital discharges
Audit Fear
The Problem:
Providers worry incomplete documentation will trigger audits and refunds, so they avoid billing services they're actually providing.
Impact:
Practices leave $73K-$468K total opportunity on the table rather than risk audit exposure
Deep Dive: Medicare Billing Services Explained
Annual Wellness Visit (AWV)
G0438/G0439 | $174-$116 per visit
Documentation Requirements:
- • Health risk assessment questionnaire
- • Review of medical/family history
- • Vital signs including BMI
- • Cognitive assessment
- • Depression screening (PHQ-2/PHQ-9)
- • Functional ability assessment
- • Safety screening (fall risk, home safety)
- • Advanced care planning discussion
- • Personalized prevention plan
- • SDOH screening
Capture Strategy:
Voice documentation auto-fills all 10+ required elements during natural conversation, eliminating 15-20 min post-visit documentation.
Common Billing Mistakes:
- × Missing required elements → denied claim
- × Incomplete documentation → audit risk
- × Billing same year as physical exam
Transitional Care Management (TCM)
99495/99496 | $191-$282 per transition
Documentation Requirements:
- • Patient contact within 2 business days (99495) or same day (99496)
- • Face-to-face visit within 7 or 14 days
- • Medication reconciliation
- • Review of discharge summary
- • Coordinate follow-up care
- • Document all touchpoints and time
Capture Strategy:
Automated TCM tracking flags eligible patients on discharge, prompts timely contact, documents all interactions with timestamps.
Common Billing Mistakes:
- × Missing 2-day contact window
- × Inadequate documentation of communication
- × Billing both TCM and E/M for same visit
Chronic Care Management (CCM)
99490/99439/99487/99489 | $43-$138 per patient per month
Documentation Requirements:
- • 20+ minutes non-face-to-face care coordination
- • Comprehensive care plan
- • 24/7 access to care team
- • Electronic care plan accessible to patient
- • Medication management
- • Communication with other providers
- • Time tracking for all activities
Capture Strategy:
Automatic time tracking of phone calls, care coordination, medication reviews. Care plan auto-generated from visit documentation.
Common Billing Mistakes:
- × Not tracking time accurately
- × Missing monthly 20-minute threshold
- × Lack of comprehensive care plan documentation
Behavioral Health Integration (BHI)
99484/G0511 | $85-$140 per patient per month
Documentation Requirements:
- • PHQ-9 or GAD-7 screening at baseline and follow-up
- • Psychiatric collaborative care model
- • Care manager time tracking (20+ min/month)
- • Psychiatric consultant case review
- • Systematic tracking of clinical outcomes
- • Treatment plan adjustments based on outcomes
Capture Strategy:
Integrated PHQ-9 capture during visits, automated time tracking for care managers, collaborative care documentation templates.
Common Billing Mistakes:
- × Missing baseline or follow-up screenings
- × Inadequate psychiatric consultant involvement
- × Poor tracking of care manager time
How OrbDoc Automates Medicare Billing Capture
Technology that eliminates documentation burden while ensuring compliance
AWV Automation
15-20 minutes per AWV- ✓ Voice-captured health risk assessment (all 10+ elements)
- ✓ Auto-populated SDOH screening from conversation
- ✓ Integrated PHQ-9 depression screening
- ✓ Fall risk and functional assessment documentation
- ✓ One-click personalized prevention plan generation
TCM Automation
10-15 minutes per transition- ✓ Automatic discharge notification flagging
- ✓ 2-day contact window countdown alerts
- ✓ Timestamped documentation of all patient communications
- ✓ Medication reconciliation workflow
- ✓ Auto-generated TCM billing package with evidence
CCM Automation
5-8 hours per month practice-wide- ✓ Automatic time tracking (phone, portal, coordination)
- ✓ Real-time monthly time accumulation dashboard
- ✓ Auto-generated comprehensive care plans from visit notes
- ✓ Patient care plan portal access
- ✓ Monthly billing readiness alerts
BHI Automation
3-5 hours per month practice-wide- ✓ Integrated PHQ-9/GAD-7 capture during visits
- ✓ Automatic outcome tracking over time
- ✓ Care manager time tracking and documentation
- ✓ Collaborative care workflow templates
- ✓ Psychiatric consultant review documentation
Total Practice Time Savings:
12-18 hours per week
Across all Medicare billing services for typical 5-provider practice
Real-World Case Study: $45K → $218K Revenue Capture
8-Provider Family Medicine Practice
The Problem
Eligible for $180K-$220K annual Medicare revenue (AWV, TCM, CCM, BHI) but only capturing $45K due to documentation burden and workflow gaps
Previous Audit Risk:
Previous AWV audits revealed incomplete documentation, practice refunded $12K
The Implementation
Deployed Medicare billing optimization workflows across all providers
Patient Panel:
12,000 active Medicare patients
"The documentation burden made revenue capture impossible. Automation handles the work. We bill for services we're already providing."
— Practice Administrator, Family Medicine Practice
ANNUAL REVENUE CAPTURED
$218K annual revenue capture (from $45K baseline)
48x ROI on technology investment
DOCUMENTATION INTEGRITY
Zero audit findings in Year 1 - complete documentation integrity
Complete audit trail with evidence-linking
30-60-90 Day Revenue Ramp
Structured implementation timeline to maximize Medicare billing capture
Days 1-7: Setup
- ✓ Configure Medicare billing workflows
- ✓ Set up AWV, TCM, CCM, BHI templates
- ✓ Train staff on automated documentation
- ✓ Identify eligible patient populations
Days 8-30: Pilot
- ✓ 2-3 providers pilot AWV automation
- ✓ Test TCM tracking and alerts
- ✓ Enroll first CCM patients
- ✓ Validate billing code accuracy
Days 31-60: Scale
- ✓ Roll out to all providers
- ✓ Ramp up AWV scheduling
- ✓ Expand CCM enrollment aggressively
- ✓ Launch BHI program for eligible patients
Days 61-90: Optimize
- ✓ Hit 50%+ AWV capture rate
- ✓ Capture 70%+ eligible TCM services
- ✓ 300+ patients enrolled in CCM
- ✓ BHI program generating $5K-$10K/month
Expected Revenue Impact by Day 90:
$50K-$120K captured
For typical 5-provider primary care practice
Ready to Calculate Your Revenue Opportunity?
Contact us for a personalized revenue analysis based on your practice size, Medicare patient volume, and current AWV/CCM capture rates.
Small Practice (2-5 Providers)
$73K-$135K
Annual opportunity
Mid-Size Practice (5-10 Providers)
$145K-$275K
Annual opportunity
Large Practice (10-20 Providers)
$260K-$468K
Annual opportunity
Calculation Assumptions:
AWV: $140 avg reimbursement | TCM: $230 avg | CCM: $65/patient/month | BHI: $110/patient/month
Based on Medicare Fee Schedule and typical primary care patient demographics.
"We were missing $87K annually in AWV and CCM revenue because the documentation burden was impossible. Automation handles it. Our providers leave on time now, and we captured $218K in Year 1. Save 2+ hours daily per provider."
Practice Administrator
5-provider Family Medicine Practice, 12 years managing billing
Related Solutions
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Audit Defense with Evidence-Linking
60-second audit response with claim-level audio timestamps for Medicare billing confidence
Ready to Capture $223K-$468K in Medicare Revenue?
No billing team required. Leave work on time while optimizing revenue automatically.
Small primary care practices capturing AWV, CCM, and TCM revenue without billing specialists