ACCESS pays a co-management fee of roughly $100 per beneficiary per year to the clinician who reviews the care record and documents coordination — longitudinal management, decoupled from visit volume. Whether a PT practice qualifies as that co-managing clinician is the first question to settle, not the last: CMS frames the role around primary care, and we will not tell you it is answered when it isn't. JointCoach provides the RTM data layer, PROM engine, and physician-attested compliance infrastructure — and the physician relationships to sit behind the co-management role if your practice cannot hold it alone.
ACCESS is not just an OAP check. For PT practices using JointCoach, the full revenue architecture spans pre-ACCESS RTM, the ACCESS co-management fee, and post-ACCESS RTM resumption.
JointCoach RTM (CPT 98985 + 98979) runs 1–3 months before ACCESS enrollment — ordered at the patient's in-person visit for their presenting complaint, so the billing-practitioner relationship and initiating visit are already in place. Establishes digital literacy and collects baseline PROMs. Revenue continues during this phase.
RTM ActiveYour practice earns $100/pt/yr as the co-managing clinician. Monthly digital check-ins (~3×/year review, no extra visits required). RTM billing pauses to avoid Substitute Spend penalty.
Core RevenueAfter the 12-month ACCESS period, RTM billing resumes at full rate (~$1,260/yr/pt via CPT 98977 + 98980). Patients remain on JointCoach. Revenue scales with panel size.
RTM ResumesEvery PT practice is different. Practices inside ACO networks follow a different on-ramp than post-discharge orthopedic practices. JointCoach supports both.
Your ACO or PCP partner identifies beneficiaries with chronic MSK via claims analysis or HIE queries. Chronic MSK pain > 3 months required.
PT performs initial functional evaluation under FFS. Confirms eligibility and biopsychosocial complexity. Low-complexity patients route digital-first.
Enroll patients into ACCESS via JointCoach. Monthly digital PROM check-ins. PT remains clinical hub for triage and care decisions throughout the 12-month period.
Deliver standard in-person care for the presenting complaint. JointCoach RTM runs in parallel during the FFS episode — building baseline data and digital habits.
Flag patients with chronic MSK near discharge — those likely to remain symptomatic or benefit from longitudinal support. JointCoach surfaces PROM trends to guide triage.
Enroll for 12-month longitudinal support and outcome tracking. RTM pauses during ACCESS to avoid Substitute Spend penalty — resumes at full rate post-program.
CMS ACCESS requires audit-ready PROM collection at baseline, quarterly, and end-of-period. JointCoach auto-collects every instrument on schedule — no staff follow-up required.
| Category | Instrument | Indication | Success Threshold | Collection Schedule |
|---|---|---|---|---|
| Generic | PROMIS Physical Function 6b/CAT | All MSK | ↑ 2-pt T-score | BQE |
| PROMIS Pain Interference 6a/CAT | All MSK | ↑ 2-pt T-score | BQE |
|
| Site-Specific | KOOS JR | Knee | ↑ 10 pts | BQE |
| HOOS JR | Hip | ↑ 10 pts | BQE |
|
| Oswestry (ODI) | Back | ↓ 8 pts | BQE |
|
| Neck Disability Index (NDI) | Neck | ↓ 8 pts | BQE |
|
| QuickDASH | Shoulder/Arm | ↓ 10 pts | BQE |
|
| Pain | NRS 0–10 | All MSK | ≤ 2-pt increase | BQE |
| Global | PGIC | All MSK | Qualitative anchor | E |
B Baseline (Day 0–60) · Q Quarterly (Month 3, 6, 9) · E End-of-Period (Day 425 + PGIC) · Goal: ≥50% of enrolled patients meeting improvement threshold (OAT).
MSOs, PE-backed groups, and practices with complex ownership structures: the affiliation and substitute spend rules are the most consequential part of ACCESS. Read them before you structure any partnership.
For large PT groups or MSO-backed practices: if your management company or PE sponsor owns ≥5% of the ACCESS entity you create, your entire PT practice loses FFS billing capability for those patients. Structure carefully.
Complete transition to ACCESS for that patient population. Embrace FFS exclusion as a feature, not a bug.
Structure partnership via service contracts, not equity. Keep cross-ownership below 5% to maintain FFS billing for non-enrolled patients.
JointCoach's RTM billing intentionally pauses during the 12-month ACCESS period to keep your SST below 10%. This is not an accident — it's the sequencing that protects your reconciliation payment. Pre- and post-ACCESS RTM remains fully billable.
Hinge Health and Sword are B2B employer plays. RevelAI and Limber are PT tools. Neither captures downstream surgical revenue or closes the surgeon ↔ patient ↔ PT loop. JointCoach does.
JointCoach guides your practice through every step — from Cohort 2 application through first patient onboarded and first PROM collected.
The program went live in July 2026 with Cohort 1 underway; CMS accepts subsequent cohorts on a quarterly rolling basis, with Cohort 2 anticipated in Jan 2027. Tell us about your practice and we'll walk through whether JointCoach is the right fit — and what your enrollment and revenue timeline looks like.