And the flag is out! or at least it’s being proposed!
Third-party remote patient monitoring vendors were caught offside in the proposed rule for the 2027 Medicare Physician Fee Schedule, which would bar reimbursement for RPM services unless they’re performed by clinical staff that’s directly employed by the practice doing the billing.
Drastic times call for drastic measures. 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.
- It also pointed out that Medicare lacks basic information needed to properly bill for RPM, like who ordered the monitoring in the first place.
CMS means business. Although the OIG’s concerns seem like some pretty good levers to pull before taking the nuclear option, the latest estimates show that Medicare could recover over $4B from criminal cases filed in the last six months alone.
The proposed rule pins the problem on vendors:
- Medicare would only reimburse RPM and RTM when they’re performed by clinical staff employed by the billing practice, not third-party companies (pretty much every RPM company we’ve ever covered).
- The rule would also require a separate visit to kick off any remote monitoring episode, limiting the service to patients that have an established relationship with the billing practice.
That would effectively end RPM as we know it. CMS is proposing to throw the baby out with the bathwater, eliminating the bad actors at the expense of the good ones – and their patients.
The initial response was predictably… not great:
- Brook.ai CEO Oren Nissim summed it up nicely. “We fully support CMS’s goal of ensuring remote care is driven by clinical need, integrated into physician-directed care, and delivered through close collaboration between physicians and integrated clinical teams. The challenge is strengthening oversight while preserving the collaborative care models that help providers expand access, extend clinical capacity, and deliver high-quality longitudinal care at scale.”
- Cadence CEO Chris Altech shared a similar sentiment. “The challenge is that the proposal doesn’t distinguish at all between low quality RPM and clinically integrated programs… The result of the current rule in its current form will be more untreated chronic disease, higher downstream costs for Medicare.
The Takeaway
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? You can let CMS know what you think until September 16th.
