One patient, month by month
A patient who is enrolled is not always a patient who can be billed. Billing depends on enough days of readings and enough minutes of staff time each month. This build follows one invented patient and then a group of 100, so the average and the spread behind it are both visible.
What this shows
- Setup billed once in month 0, then the monthly codes each month's inputs earn
- The share of patients who reach each threshold, by month since start
- Expected revenue per enrolled patient, month by month and over 12 months
- A group of 100 invented patients showing the spread behind the average
How I use it
- Explaining why enrolled patients and billable patients are different numbers
- Seeing how much revenue depends on one threshold, such as days of readings
- Setting the revenue per patient used in a larger forecast
Explore the model below. It uses an invented company and invented numbers.
Explore the model
Illustrative model · Synthetic dataWide tables scroll sideways: swipe inside a table to see every column.
Sample build: one patient, month by month
An invented remote care program. It follows one invented patient for 12 months, then every enrolled patient on average, then a group of 100. Billing codes are public numbers, described here in plain words. The rates are rounded and illustrative, not the fee schedule.
Invented patients and invented numbers for illustration. Illustrative rates, not the fee schedule.
What to try
- Pick Fades out, then Slow start, and compare the 12-month totals.
- Select a month and move its days of readings from 15 to 16. The device code changes.
- Move the monitoring minutes from 19 to 20, then from 39 to 40, and watch the added blocks.
- Switch off the live contact. The monitoring codes disappear.
Readings hover around the 16-day line, so the device code flips between the full and lower versions. Month 9 has staff time but no live contact.
Month 1: change what this patient did
Staff time logged: 55 minutes. Each minute is counted in one program only.
12-month total
$1,922
Setup of $20 plus $1,902 in months 1 to 12.
Average month
$158.50
Months 1 to 12.
Months with the full device code
8 of 12
4 with the lower code and 0 with none.
Months with staff time billed
11 of 12
Monitoring staff time. Chronic care bills in 11.
Billed each month, by group of codes
| Month | Days of readings | Monitoring minutes | Live contact | Chronic care minutes | Codes billed | Billed | Running total |
|---|---|---|---|---|---|---|---|
| n/a | n/a | n/a | n/a | 99453 | $20 | $20 | |
| 22 | 30 | Yes | 25 | 994549945799490 | $155 | $175 | |
| 18 | 25 | Yes | 30 | 994549945799490 | $155 | $330 | |
| 15 | 18 | Yes | 20 | 994459947099490 | $116 | $446 | |
| 20 | 35 | Yes | 45 | 99454994579949099439 | $200 | $646 | |
| 14 | 15 | Yes | 22 | 994459947099490 | $116 | $762 | |
| 21 | 25 | Yes | 15 | 9945499457 | $95 | $857 | |
| 17 | 40 | Yes | 30 | 99454994579945899490 | $195 | $1,052 | |
| 16 | 22 | Yes | 25 | 994549945799490 | $155 | $1,207 | |
| 12 | 12 | No | 20 | 9944599490 | $90 | $1,297 | |
| 19 | 30 | Yes | 40 | 99454994579949099439 | $200 | $1,497 | |
| 15 | 20 | Yes | 25 | 994459945799490 | $140 | $1,637 | |
| 18 | 45 | Yes | 62 | 9945499457994589949099439x2 | $285 | $1,922 |
Month 1: which codes bill and why
| Code | Result | Why |
|---|---|---|
| 99453 | Not billed | Not billed: setup bills once, in month 0. |
| 99454 | $45 | 22 days of readings is 16 or more, so the full device code bills. |
| 99445 | Not billed | Not billed: the full device code bills instead, and only one of the two can. |
| 99457 | $50 | 30 minutes with a live contact: the first 20 minutes bill. |
| 99470 | Not billed | Not billed: 20 minutes or more bills the 20-minute code instead. Only one of the two can. |
| 99458 | Not billed | Not billed: 30 minutes does not reach 40, so there is no extra full block. |
| 99490 | $60 | 25 minutes of chronic care staff time: the first 20 minutes bill. |
| 99439 | Not billed | Not billed: 25 minutes does not reach 40, so there is no extra full block. |
Rules this page applies
- Setup bills once, in month 0, and never again.
- Only one device code bills in a month. 16 or more days of readings bills the full code, 2 to 15 days bills the lower one, and under 2 days bills neither.
- Monitoring staff time needs at least one live two-way contact in the month. Only one of the 10-minute and 20-minute codes bills, and each further full 20 minutes adds one unit after the 20-minute code.
- Monitoring staff time has no days-of-readings test, so it can bill in a month when no device code does.
- Chronic care time bills alongside monitoring, but a minute of staff time counts toward one program only.
- Only one practitioner can bill remote monitoring for a patient in a 30-day period, and the patient must already be established with the practice. This page assumes both.
Minutes count once
Month 1 logs 55 minutes of staff time: 30 counted to monitoring and 25 counted to chronic care. Together they are credited 55 minutes, so each minute counts once.
Codes, illustrative rates and tests
| Code | Kind | What it covers | When it bills | Rate |
|---|---|---|---|---|
| 99453 | Once | Set up the device and teach the patient to use it | Bills once, in month 0. It never repeats. | $20 |
| 99454 | Monthly | Device supplied, readings sent on 16 or more of 30 days | 16 or more days of readings. Cannot bill with 99445. | $45 |
| 99445 | Alternative to 99454 | Device supplied, readings sent on 2 to 15 of 30 days | 2 to 15 days of readings. Cannot bill with 99454. | $30 |
| 99457 | Time based | Staff time reviewing readings and talking with the patient, first 20 minutes | 20 or more minutes and a live two-way contact. Cannot bill with 99470. | $50 |
| 99470 | Alternative to 99457 | The same staff time, first 10 minutes | 10 to 19 minutes and a live two-way contact. Cannot bill with 99457. | $26 |
| 99458 | Time based | Each further full 20 minutes of that staff time | Only after 99457. One unit for each full 20 minutes beyond the first 20. | $40 |
| 99490 | Time based | Care planning for a chronic condition, first 20 minutes of staff time | 20 or more minutes in the month. | $60 |
| 99439 | Time based | Each further full 20 minutes of chronic care staff time | Only after 99490. One unit for each full 20 minutes beyond the first 20. | $45 |
What to try
- Pick Weak program, then Strong program, and read the 12-month lifetime value.
- Slide monthly retention down by 5 points and compare it with a 10 point drop in the 16 day share.
- Switch the shares to patients still in the program to see enrolled and billable come apart.
The starting settings for this page.
How the shares are built
- Month 1 starts from the three shares you set. Each then falls in a straight line to month 12 by the fall you set.
- Retention applies from month 2: each month keeps the stated share of the month before. Everyone is still enrolled in month 1.
- Of patients who miss 16 days, 60% still send 2 to 15.
- Of patients who miss 20 monitoring minutes, 50% reach 10 to 19. Of those who reach 20, 40% reach 40, and of those 25% reach 60.
- Chronic care follows the same steps above 20 minutes: 40% of those reach 40, and 25% of those reach 60.
- The three groups of codes are priced one at a time and added, so they do not need to be independent.
12-month lifetime value
$1,292
Per enrolled patient, setup included, at 95% monthly retention.
Expected, month 1
$148.90
Per enrolled patient. Everyone is still in the program.
Expected, month 12
$71.28
56.9% of enrolled patients are still in the program.
Billing the full device code, month 12
34.1%
Share of all enrolled patients.
Share reaching each threshold, by month since start
Show the numbers behind the chart
| Month | Still enrolled | Readings 2+ days | Readings 16+ days | Monitoring 10+ min | Monitoring 20+ min | Monitoring 40+ min | Monitoring 60+ min | Chronic 20+ min | Chronic 40+ min | Chronic 60+ min |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 100.0% | 90.0% | 75.0% | 85.0% | 70.0% | 28.0% | 7.0% | 70.0% | 28.0% | 7.0% |
| 2 | 95.0% | 85.0% | 70.0% | 80.1% | 65.3% | 26.1% | 6.5% | 65.3% | 26.1% | 6.5% |
| 3 | 90.3% | 80.2% | 65.2% | 75.6% | 60.9% | 24.4% | 6.1% | 60.9% | 24.4% | 6.1% |
| 4 | 85.7% | 75.8% | 60.8% | 71.2% | 56.7% | 22.7% | 5.7% | 56.7% | 22.7% | 5.7% |
| 5 | 81.5% | 71.5% | 56.6% | 67.2% | 52.9% | 21.1% | 5.3% | 52.9% | 21.1% | 5.3% |
| 6 | 77.4% | 67.5% | 52.8% | 63.3% | 49.2% | 19.7% | 4.9% | 49.2% | 19.7% | 4.9% |
| 7 | 73.5% | 63.8% | 49.1% | 59.7% | 45.8% | 18.3% | 4.6% | 45.8% | 18.3% | 4.6% |
| 8 | 69.8% | 60.2% | 45.7% | 56.2% | 42.7% | 17.1% | 4.3% | 42.7% | 17.1% | 4.3% |
| 9 | 66.3% | 56.8% | 42.5% | 53.0% | 39.7% | 15.9% | 4.0% | 39.7% | 15.9% | 4.0% |
| 10 | 63.0% | 53.6% | 39.5% | 50.0% | 36.9% | 14.8% | 3.7% | 36.9% | 14.8% | 3.7% |
| 11 | 59.9% | 50.6% | 36.7% | 47.1% | 34.3% | 13.7% | 3.4% | 34.3% | 13.7% | 3.4% |
| 12 | 56.9% | 47.8% | 34.1% | 44.4% | 31.9% | 12.7% | 3.2% | 31.9% | 12.7% | 3.2% |
Expected amount billed per enrolled patient, by month
Running total over 12 months
The expected line already allows for patients who leave. The invented patient on the first tab reaches $1,922 against an expected $1,292, so that patient sits above the expected line.
Show the monthly numbers behind both charts
| Month | Still enrolled | Setup | Device | Monitoring staff time | Chronic care staff time | Expected | Running total | Invented patient, running |
|---|---|---|---|---|---|---|---|---|
| 0 | 100.0% | $20.00 | $0.00 | $0.00 | $0.00 | $20.00 | $20.00 | $20.00 |
| 1 | 100.0% | $0.00 | $38.25 | $52.90 | $57.75 | $148.90 | $168.90 | $175.00 |
| 2 | 95.0% | $0.00 | $35.99 | $49.57 | $53.87 | $139.42 | $308.32 | $330.00 |
| 3 | 90.3% | $0.00 | $33.86 | $46.43 | $50.22 | $130.51 | $438.83 | $446.00 |
| 4 | 85.7% | $0.00 | $31.85 | $43.49 | $46.81 | $122.15 | $560.98 | $646.00 |
| 5 | 81.5% | $0.00 | $29.96 | $40.72 | $43.62 | $114.30 | $675.28 | $762.00 |
| 6 | 77.4% | $0.00 | $28.17 | $38.13 | $40.62 | $106.92 | $782.20 | $857.00 |
| 7 | 73.5% | $0.00 | $26.49 | $35.69 | $37.82 | $100.00 | $882.20 | $1,052.00 |
| 8 | 69.8% | $0.00 | $24.91 | $33.40 | $35.20 | $93.50 | $975.70 | $1,207.00 |
| 9 | 66.3% | $0.00 | $23.42 | $31.24 | $32.74 | $87.41 | $1,063.11 | $1,297.00 |
| 10 | 63.0% | $0.00 | $22.02 | $29.23 | $30.44 | $81.68 | $1,144.79 | $1,497.00 |
| 11 | 59.9% | $0.00 | $20.70 | $27.33 | $28.29 | $76.32 | $1,221.11 | $1,637.00 |
| 12 | 56.9% | $0.00 | $19.45 | $25.55 | $26.28 | $71.28 | $1,292.39 | $1,922.00 |
Month 6: expected revenue is the sum over the outcomes
22.6% of enrolled patients have left by month 6 and bill nothing. Each other patient lands in one outcome for each group of codes. Multiply each share by what that outcome bills, then add the groups.
| Outcome | Share of enrolled patients | Billed if it happens | Share times billed |
|---|---|---|---|
| Device readings | |||
| Under 2 days of readingsNo code bills | 9.85% | $0 | $0.00 |
| 2 to 15 days of readings99445 | 14.77% | $30 | $4.43 |
| 16 or more days of readings99454 | 52.76% | $45 | $23.74 |
| Subtotal, device readings | 77.38% | $28.17 | |
| Monitoring staff time | |||
| Under 10 minutes, or no live contactNo code bills | 14.07% | $0 | $0.00 |
| 10 to 19 minutes99470 | 14.07% | $26 | $3.66 |
| 20 to 39 minutes99457 | 29.54% | $50 | $14.77 |
| 40 to 59 minutes99457, 99458 | 14.77% | $90 | $13.29 |
| 60 to 79 minutes99457, 99458 x2 | 4.92% | $130 | $6.40 |
| Subtotal, monitoring staff time | 77.38% | $38.13 | |
| Chronic care staff time | |||
| Under 20 minutesNo code bills | 28.14% | $0 | $0.00 |
| 20 to 39 minutes99490 | 29.54% | $60 | $17.73 |
| 40 to 59 minutes99490, 99439 | 14.77% | $105 | $15.51 |
| 60 to 79 minutes99490, 99439 x2 | 4.92% | $150 | $7.39 |
| Subtotal, chronic care staff time | 77.38% | $40.62 | |
| Expected revenue per enrolled patient | $106.92 | ||
What moves the 12-month lifetime value
The 12-month lifetime value is $1,292. The change that costs most is "monthly retention falls 5 points", which takes off $270.
| Change | 12-month lifetime value | Change in value |
|---|---|---|
| Monthly retention falls 5 points | $1,023 | -$270 |
| Share reaching 20 chronic care minutes falls 10 points | $1,223 | -$69 |
| The fade over the year grows by 10 points | $1,244 | -$48 |
| Share reaching 20 monitoring minutes falls 10 points | $1,245 | -$48 |
| Share reaching 16 days of readings falls 10 points | $1,270 | -$23 |
What to try
- Move everyone's days of readings down by 1 and watch the patients at the 16-day line drop to the lower code.
- Switch the spread to Revenue per patient and select a band to see who is in it.
- Move monitoring minutes down by 10 and see how many patients fall under a time threshold.
One month for 100 invented patients, each with their own days of readings, monitoring minutes and chronic care minutes. Some logged staff time but made no live contact. Every patient is billed with the same rules as the first tab.
Average per patient
$156.00
The group's expected revenue for one patient in a month. $15,600 across 100 patients.
The middle patient
$155.00
60 of 100 patients bill less than the average.
Patients billing nothing
1
No device, staff time or chronic care code. The most anyone bills is $285.
The curve for month 1
$148.90
The group sits $7.10 above it. A group of 100 does not match a curve exactly.
Patients by days of readings
| Band | Patients | Share of the group |
|---|---|---|
| 8 | 8% | |
| 7 | 7% | |
| 10 | 10% | |
| 35 | 35% | |
| 40 | 40% |
Time logged, nothing billed
| Outcome | Patients | Share |
|---|---|---|
| Readings: Under 2 days | 8 | 8% |
| Readings: 2 to 15 days | 17 | 17% |
| Readings: 16 or more days | 75 | 75% |
| Monitoring time: No code: under 10 minutes, or no live contact | 15 | 15% |
| Monitoring time: 10 to 19 minutes | 15 | 15% |
| Monitoring time: 20 to 39 minutes | 40 | 40% |
| Monitoring time: 40 to 59 minutes | 20 | 20% |
| Monitoring time: 60 minutes or more | 10 | 10% |
| Chronic care time: Under 20 minutes | 30 | 30% |
| Chronic care time: 20 to 39 minutes | 35 | 35% |
| Chronic care time: 40 to 59 minutes | 25 | 25% |
| Chronic care time: 60 minutes or more | 10 | 10% |
| Code | Patients billing it | Units | Billed |
|---|---|---|---|
| 99454 | 75 | 75 | $3,375 |
| 99445 | 17 | 17 | $510 |
| 99457 | 70 | 70 | $3,500 |
| 99470 | 15 | 15 | $390 |
| 99458 | 30 | 40 | $1,600 |
| 99490 | 70 | 70 | $4,200 |
| 99439 | 35 | 45 | $2,025 |
| Group total | $15,600 |
Checks that run on every change: 7 of 7 pass
Pass Inputs are in range
Every setting is between 0 and 100 percent.
Pass No code bills that the rules forbid
Checked months 0 to 12: one device code at most, one of the 10 and 20 minute codes, added blocks only after the first, setup once.
Pass Code lines add to each month and the running total rolls forward
Lines, families and months all tie.
Pass Each minute of staff time is counted in one program only
Minutes credited equal minutes logged in every month.
Pass Retention never rises and never goes above 100 percent
Still enrolled falls from 100% to 56.9%.
Pass Outcome shares add to 100 percent and expected revenue is the weighted sum over the outcomes
Checked every month, and again by counting expected units of each code.
Pass The group of 100 adds up
Outcome counts, code lines and patient totals all give $15,600.
At 95% monthly retention, an enrolled patient is expected to bill $1,292 over 12 months, including setup. The invented patient bills $1,922, and the group of 100 averages $156.00 for a month.