Most Primary Care Practices Are Missing Up to $647,000 a Year in Medicare Revenue -- Here Is Why

CMS’s 2025 Advanced Primary Care Management program pays monthly per-patient fees for care already delivered, yet most practices haven’t enrolled any patients.

BETHESDA, MD, UNITED STATES, March 10, 2026 /EINPresswire.com/ -- Many primary care practices are working harder every year for the same -- or worse -- financial results. Reimbursements are flat, overhead keeps rising, and seeing more patients is not a realistic answer.
The better path is capturing revenue for care already being delivered but not getting paid for.

THE REVENUE GAP MOST PRACTICES DO NOT KNOW EXISTS
Medicare has expanded its payment programs for primary care over the last several years. In 2025, CMS introduced the most significant of these: Advanced Primary Care Management (APCM). It pays a monthly per-patient fee for ongoing care management -- and most primary care practices have not yet enrolled a single patient.

REVENUE SNAPSHOT
A practice with 1,000 eligible Medicare patients enrolling in APCM at the G0557 rate ($53.91/month) generates $647,000 in annual recurring revenue -- without a single additional appointment.
WHAT IS APCM?
APCM (G0556, G0557, G0558) is CMS's 2025 consolidation of fragmented chronic care management codes, bundling CCM, PCM, and TCM into one monthly payment based on patient complexity -- not time spent.
G0556 covers 1 or fewer chronic conditions at approximately $16.70 per patient per month. G0557 covers 2 or more chronic conditions at $53.91 per patient per month. G0558 covers 2 or more conditions plus Qualified Medicare Beneficiary status at $117.53 per patient per month.
CMS raised these rates by approximately 10 percent for 2026, making early adoption more valuable.

WHY MOST PRACTICES LEAVE THIS MONEY UNCOLLECTED
The barrier is not eligibility -- most practices have hundreds of qualifying patients. The barrier is operational. Running APCM manually requires patient outreach calls, individualized electronic care plans, clinical triage documentation, and monthly billing artifact creation. Without automation, this is not feasible at scale.

HOW TILE HEALTH SOLVES THE OPERATIONAL PROBLEM
Tile Health (https://www.tilehealthcare.com) is an AI-powered APCM billing platform built specifically for primary care practices. It automates the entire workflow from patient enrollment through billing -- without adding headcount.
Tile Health handles AI-powered patient identification and outreach calls, automated clinical triage using validated OPQRST protocols, CMS-compliant individualized electronic care plan generation, real-time risk stratification and task routing to clinical staff, and monthly billing artifact generation ready for direct submission to Medicare.
Practices retain full control of the billing relationship with Medicare. Tile Health generates the compliant artifacts; the practice submits the claims.

THE ECONOMICS
Legacy care management vendors typically take 50 to 70 percent of APCM revenue in exchange for running manual call center operations. Tile Health's AI-first model charges a flat fee, allowing practices to retain 60 to 70 percent of every dollar billed. For a 1,000-patient panel, that difference can be $200,000 or more per year.

OTHER REVENUE STREAMS
APCM is the largest opportunity, but not the only one. Tile Health's platform also helps practices capture Annual Wellness Visits (AWVs), which Medicare covers 100 percent for eligible beneficiaries, Behavioral Health Integration (BHI) codes for patients with depression, anxiety, or substance use, and Remote Physiologic Monitoring (RPM) for patients already using connected devices. Many of these can be billed alongside APCM, stacking revenue from the same patient population.

IMPLEMENTATION TIMELINE
Tile Health gets practices live within 30 days. Days 1 through 2 cover data sync and patient list upload. Days 3 through 5 cover AI configuration. Days 6 through 7 cover patient notification. Days 7 through 14 see AI enrollment and triage begin. By day 30, the first billing file is generated.

Ali Elmarsafawy
Tile Health
+1 281-404-5981
email us here
Visit us on social media:
LinkedIn

Legal Disclaimer:

EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.