Software can evaluate, educate and support a patient all the way to the edge of a decision. It cannot make the decision count. So we put a short virtual evaluation at the end: the patient leaves with a real result, the physician is paid for real work, and the record behind both is attested and checkable.
This is not a discount button on a checkout page. It is the shortest defensible path from a patient's question to a physician's signature — and the reason the signature is worth something is that it is short, not that it is skipped.
Structured intake in the patient's own words: the condition, the history, the medication, the document that proves it. Branching, with honest ends built in.
The patient learns what actually determines their case — the diagnosis, the but-for test, the document — before anyone asks them for money.
Gaps get named: the report to request, the clinician to ask, the answer that will end this honestly. Most people are helped here without a visit at all.
A short virtual evaluation with a physician licensed in the patient's state, against published criteria, with the packet already assembled. Sign, decline in writing, or ask for one document.
The determination is bound to an NPI, timestamped, and anchored as a PHI-free receipt anyone can verify.
Not a maybe, and not a wait. One of four things, each written down:
The visit is real work and is paid as such — the assessment, the education already done, the plan adopted, the monitoring reviewed. The attested record is what makes it billable and what defends it later.
The tax objection. The IRS's 2024 alert exists because companies sold letters written from self-reported questionnaires. A brief evaluation by a licensed physician, against published criteria, with a document in the packet, is a different artefact from a form-filled note — and it is the version an administrator can defend.
The reimbursement objection. Attestation alone does not create billable work; the treating encounter does. Put a real, short encounter at the end and the physician is doing something Medicare and commercial payers already recognise — assessment, care planning, caregiver training, monitoring review — with the documentation generated as a by-product instead of an evening's admin.
The window. The Consolidated Appropriations Act, 2026 extended the major Medicare telehealth flexibilities through 31 December 2027 — home as an originating site, no geographic restriction, audio-only where clinically appropriate, and the expanded practitioner list. A virtual-first model is not a workaround right now; it is the supported path, with a date on it.
Not one vertical. The common shape is: software gets a patient to the edge of a clinical decision, and the company has no licensed physician to finish it — or has physicians whose time is too expensive to spend on the last four minutes.
Hypertension, diabetes, CKD, musculoskeletal pain, depression. Many are new to Medicare and now carry clinical oversight, licensure and outcome-reporting obligations they have never had.
Devices generate data all month; payment turns on a clinician reviewing it and making a decision. That review is the bottleneck and the audit exposure.
Real customers with real diagnoses, mixed in with customers who have none. The honest split is the whole product, and neither the brand nor a percentage-paid reviewer can be the one to make it.
Aging at home, post-discharge, dementia. The clinical decisions are constant and the clinician is usually the hardest person in the room to reach.
Prevention visits, advance care planning, caregiver training, care-plan revisions — services that exist, pay, and go unbilled because the documentation burden exceeds the payment.
They carry the substantiation risk for every letter their members present. A determination with a public receipt and a named physician is the only kind that reduces it.
Drafts a model produces — a plan, a summary, a rationale — are held until a named physician attests them. Drafting partners plug in on the far side of the gate.
People arrive already searching for the thing that is wrong. The evaluation can start at the moment of the question rather than at a checkout.
A family talks it through, decides, and then discovers that nothing they decided is written anywhere a clinician or a plan can act on. The visit is where the family's decision becomes part of the record — and where the clinician's work around it becomes payable.
They answer as proxy, and the record says so. The reviewing physician is licensed where the parent lives, not where the child does.
The two weeks when everything is decided and nobody is documenting. Assessment, plan, and the training the family actually needs to do it safely.
Care navigation, caregiver support and respite are funded in the GUIDE Model for patients who have an unpaid primary caregiver.
Goals of care, written down, in the patient's words, adopted by a physician — instead of a decision remembered differently by four people.
Education about what is actually happening, a determination about whether supervised training treats it, and a document that survives an audit.
They get told so, in writing, in two minutes, for nothing — and they keep their money and their record clean.
Scale here means a physician's judgment reaches more decisions — never that fewer judgments are made. Every case is individual, every reviewer is paid the same for a no, no service is offered before the medical director signs its criteria, and no letter issues without the document behind it.
Nothing on this page is medical, billing or tax advice, and none of it guarantees payment or eligibility. Telehealth rules, codes and model terms change — the dates here are current as of writing and should be confirmed against CMS. LMN determinations are live in pilot; the rest is in design, no BAA is executed yet, and pilots run on synthetic data until clinical sign-off and privacy safeguards are complete.