Medicare is implementing two significant changes to its cardiac care financing model this year. The Centers for Medicare & Medicaid Services (CMS) are moving away from a payment structure that compensates solely for services rendered and are instead prioritizing payments based on patient outcomes.<\/p>\n
Traditionally, Medicare compensated providers based on the volume of services rendered, with each procedure assigned a CPT code. Payment amounts were determined through a formula that accounted for geographic factors, malpractice costs, and practice expenses. In its recent Physician Fee Schedule rule for 2026, CMS has introduced the term \u201cprovider-managed care,\u201d enabling providers to receive additional payments if they can demonstrate that their care reduces emergency visits, lowers readmission rates, or enhances recovery outcomes.<\/p>\n
Additionally, the rule modifies Medicare\u2019s requirement for direct supervision for billing the technical component of monitoring. Previously, a physician needed to be physically present in the office for such billing to qualify. Now, this supervision can be conducted virtually. This shift allows practices to manage monitoring internally and capture both professional and technical payments, effectively threatening the long-standing role of Independent Diagnostic Testing Facilities (IDTFs).<\/p>\n
For providers, these new rules translate to increased control over patient follow-up, allowing them to retain a larger share of reimbursements. For device manufacturers, this change offers an opportunity to demonstrate measurable value and assist clinicians in navigating this swiftly evolving landscape.<\/p>\n
The New Value-Based Reimbursement Model<\/strong><\/p>\n Under the new framework, providers will continue to receive payments for the services they provide but will also earn bonuses if their care meets quality benchmarks. Consequently, reimbursement will be tied not only to volume but also to outcomes such as fewer emergency visits, reduced readmission rates, and improved recovery metrics.<\/p>\n Medicare has previously tested this concept through the Merit-based Incentive Payment System (MIPS), which adjusts payments based on performance in areas like blood pressure control or preventative screenings. The recent rule goes a step further by integrating value-based criteria directly into specific cardiac monitoring codes.<\/p>\n For instance, a cardiologist employing an ECG patch to detect arrhythmias can illustrate how early intervention prevented a hospitalization. Similarly, a primary care physician using remote monitoring for blood pressure can document how timely follow-up kept a patient stable and averted emergency care.<\/p>\n The Decline of the IDTF Advantage<\/strong><\/p>\n This alteration in the payment structure significantly impacts the business model of firms that have traditionally managed cardiac monitoring on behalf of providers. For years, IDTFs have built their businesses around providing what Medicare classifies as the \u201ctechnical component\u201d of monitoring. They employed staff to monitor devices, compile reports, and meet Medicare\u2019s direct supervision requirements. Physicians billed for interpreting results, while IDTFs were compensated for the monitoring service.<\/p>\n The proposed rule narrows this focus to a single service: CPT code 93296, which pertains to the technical component for remote interrogations of implanted cardiac devices such as pacemakers and defibrillators. Previously, billing this code required a physician\u2019s physical presence to comply with Medicare\u2019s direct supervision rule.<\/p>\n With this change, providers have the ability to manage this work internally and bill for both professional and technical components. For IDTFs, this development strips away a requirement that has long supported their role. Although this revision targets only one code, CMS historically pilots policy changes in this manner. By 2027, the same supervision model is expected to extend to all major ECG and monitoring codes.<\/p>\n Opportunities for Providers<\/strong><\/p>\n The rule change opens avenues for providers to execute monitoring programs independently. By eliminating the need for in-person supervision, Medicare enables practices to manage services internally, supervise them virtually, and bill for both the professional and technical components.<\/p>\n This shift also carries clinical implications. With internal monitoring, providers gain direct access to patient data, facilitating early intervention and preventing complications. Such early measures can steer patients away from emergency service needs and decrease readmission rates, aligning with the outcomes Medicare seeks to incentivize through value-based bonuses.<\/p>\n The rule introduces short-term billing codes for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM). Previously, providers were required to collect a minimum of 16 days of data per month to bill. Under the new CPT codes, physicians can now bill for fewer than 16 days of data and less than 20 minutes of patient interaction each month.<\/p>\n Several high-quality medical wearable devices already support extended recording capabilities. With the new codes, these data can be employed flexibly, whether collected over brief intervals or extended periods, providing providers with more choices for integrating monitoring into daily care routines.<\/p>\n For primary care physicians, who often meet patients for shorter visits, the new codes render monitoring more practical. For example, a family doctor monitoring a patient\u2019s blood pressure over a span of ten days can now bill for this service rather than forfeiting reimbursement.<\/p>\n What Providers Should Do Now<\/strong><\/p>\n With the rule now in effect, providers should aim to adapt to the necessary changes. Practices should integrate internal monitoring by establishing workflows for remote monitoring, training staff on device management, and ensuring clinicians can document outcomes in line with CMS standards.<\/p>\n Selecting the right technological partners is equally vital. Practices need more than just devices; they require reliable patient-facing mobile applications and dashboards that clinicians can seamlessly incorporate into their daily routines. Effective partnerships will provide the tools needed while permitting adaptation to individual staffing, patient, and clinical routines.<\/p>\n Education remains crucial. The new short-term codes for RPM and RTM have distinct requirements. RPM captures data from electronic devices, whereas RTM covers patient-reported outcomes, such as pain or symptoms. Practices that grasp how to apply each code and how they connect to value-based bonuses will be better positioned to capture revenue under the new system.<\/p>\n Providers who quickly adapt will retain a larger share of their reimbursements and gain access to new value-based payments. Those who lag may find themselves sidelined by rapidly evolving policy changes reshaping the landscape of cardiac care financing.<\/p>\n Photo: hudiemm, Getty Images<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Medicare is implementing two significant changes to its cardiac care financing model this year. 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