And the flag is out! or at least it’s being proposed!
Third-party remote patient monitoring vendors were caught offside in the CY 2027 MPFS proposed rule, which bars reimbursement for RPM services unless they’re performed by clinical staff that’s employed by the practice doing the billing.
CMS’s proposed change follows widespread concerns over skyrocketing costs for low-value services. Medicare started covering RPM in 2018, and payments ballooned to more than $500M by 2024.
An OIG watchdog report (also 2024) showed that 43% of Medicare beneficiaries receiving RPM weren’t getting at least one of the three required components: devices, education/setup, and treatment management.
The report also showed that Medicare lacks basic information needed to properly bill for RPM, like who ordered the monitoring in the first place.
Those seem like pretty good levers to pull before taking the nuclear option, but hey here we are.
There’s a ton of fraud in Medicare. There’s even more waste. Does that mean burning RPM to the ground is the best solution?
