Program design
Agree the population, clinical responsibilities, contracted-provider scope, escalation coverage, payer requirements and success measures.
Program and operational management
The team and processes behind every care program.
InstaMD supports patient identification, outreach and enrollment, then coordinates ongoing services with your practice and qualified contracted providers.
Operational services
From an eligible patient list to an accountable program.
Patient identification
Review rosters and EHR data for diagnoses, risk, treatment needs, payer coverage and existing program participation. Clinicians determine medical necessity.
Outreach and engagement
Contact patients, explain the proposed service in an accessible language, engage caregivers and track responses, follow-up and reasons for declining.
Eligibility, orders and consent
Confirm coverage and authorization needs, route clinical review and orders, coordinate required visits, explain cost-sharing and document consent.
Device operations
For RPM, coordinate device selection, shipping, activation, education, replacement and missing-reading outreach.
Care-team operations
Assign coordinators, maintain work queues and follow-up schedules, route exceptions and track referrals to completion.
Documentation and billing support
Maintain program-specific evidence, transmission days, qualifying activities and time where required. Support claim preparation, denials and reconciliation.
Performance management
Review enrollment, engagement, response times, care-plan progress, documentation gaps and collections. Adjust staffing and workflow with the practice.
Care coordination services
Qualified contracted providers, aligned with your practice.
Service agreements define which organization supplies personnel, verifies credentials, provides supervision, maintains records and bills. Provider availability and licensure are confirmed for the patient’s location and program.
Monitoring and treatment support
Qualified clinical staff review device trends, support patient communication and follow up on clinician-defined alerts. Practitioners retain treatment decisions.
View RPM eligibility and billing →Condition-specific coordination
A qualified care team maintains the principal-condition plan, follows medications and referrals, and coordinates with the treating specialist.
View PCM eligibility and billing →Comprehensive care coordination
Qualified clinical staff support the shared plan for multiple conditions, medication reconciliation and communication among treating clinicians.
View CCM eligibility and billing →Primary-care program support
Care coordinators support the responsible primary-care practitioner’s access, continuity, care-plan, transition and population-management arrangements.
View APCM eligibility and billing →Community resource coordination
Trained or certified auxiliary personnel connect identified barriers to relevant community resources and track whether support was obtained.
View CHI eligibility and billing →Illness navigation
Qualified navigators help patients complete complex evaluations, appointments and referrals, with oversight from the treating practitioner.
View PIN eligibility and billing →Behavioral health coordination
Qualified clinical staff support assessment and follow-up. Collaborative care additionally requires a qualified behavioral health care manager and psychiatric consultant.
View BHI eligibility and billing →Contracted nutrition care
A registered dietitian or qualified nutrition professional delivers assessment, nutrition treatment and follow-up under the appropriate referral and billing arrangement.
View MNT eligibility and billing →A staffing contract alone does not authorize Medicare billing. Confirm enrollment or reassignment, incident-to requirements where applicable, supervision, scope of practice and payer contracts. MNT uses the qualified nutrition professional’s applicable arrangement.
MSP/QMB eligibility and enrollment
Help patients access the benefits they may qualify for.
Screen and explain
- Confirm current Medicare, Medicaid and QMB status using available eligibility records.
- Screen household circumstances against the patient’s state rules; income and resource treatment differ by state.
- Explain QMB, SLMB and QI benefits without promising eligibility.
- Discuss remaining patient costs before obtaining program consent.
Apply and follow through
- Help collect required identity, income, coverage and other supporting documents.
- Assist with the appropriate state application and track requests for additional information.
- Record the eligibility decision, effective date and renewal needs.
- Update the practice’s billing records and follow up on incorrect patient balances.
Do not bill a QMB beneficiary Medicare cost-sharing for covered services, including when Medicaid pays nothing toward that cost-sharing. Other MSP categories do not provide the same blanket cost-sharing protection. Approval rests with the state; enrollment support is not a separately billable Medicare code.
Medicare benefit guidance ↗Responsibility and oversight
The practice and care team know who owns each step.
| Workstream | Practice / billing practitioner | InstaMD and contracted providers |
|---|---|---|
| Clinical decisions | Establish medical necessity, authorize treatment and approve care plans. | Collect information, coordinate qualified assessments and document authorized care. |
| Care delivery | Provide required oversight and respond to escalations. | Deliver the agreed work within each professional’s qualifications and scope. |
| Patient engagement | Maintain the clinical relationship and clarify care expectations. | Manage outreach, consent documentation, education and follow-through. |
| Documentation | Review clinical content and retain access to supporting records. | Maintain auditable, program-specific activity and service evidence. |
| Claims | Confirm the eligible billing entity, code selection and payment responsibility. | Support claim preparation and follow-up under the agreed scope; do not guarantee payment. |
Delivery options
Choose the operational support your program needs.
Program support
Identification, outreach, enrollment, device logistics, documentation or billing support to complement your existing team.
Co-managed care
Defined responsibilities across practice staff, InstaMD coordinators and qualified contracted providers.
Managed program
Coordinated operations from population review to service delivery and reporting, with clinical and billing accountability agreed before launch.