The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the 2027 Medicare Physician Fee Schedule, which includes significant changes to physician payments and value-based care programs, as well as major revisions concerning reimbursement for remote patient monitoring (RPM). <\/p>\n
In a notable shift, the agency aims to prohibit payments for remote monitoring services provided by third parties, restricting reimbursement to services delivered by clinical staff directly employed by the billing practice. CMS is also proposing to require a separate, billable visit to initiate any episode of remote patient monitoring with patients.<\/p>\n
CMS has indicated that additional changes may be forthcoming, as the agency is seeking public comments on merging the current billing codes for remote patient monitoring into a total of four new codes.<\/p>\n
These efforts are intended to update how remote monitoring services are evaluated, with CMS noting that the cost of monitoring devices often falls below initial estimates.<\/p>\n
This initiative follows a series of reports from the Department of Health and Human Services (HHS) Office of Inspector General, which highlighted issues of fraud and abuse within the realm of remote patient monitoring. The reports indicated that some companies were soliciting Medicare beneficiaries for enrollment in RPM programs regardless of medical necessity, subsequently billing for installations, training, and monitoring that were never conducted. In some instances, the necessary equipment was not delivered or lacked FDA approval.<\/p>\n
Additionally, the Inspector General’s office determined that providers sometimes enrolled patients into monitoring programs without adequate personnel to continuously monitor their data.<\/p>\n
The 2024 review revealed that nearly 43% of enrolled beneficiaries were not receiving the three required elements of service: training and setup, device provision, and treatment management. The report also noted that Medicare lacks essential baseline information, such as the identity of those who ordered the monitoring, which is necessary for proper oversight of billing practices.<\/p>\n
The proposed rule also affects eligibility for remote therapeutic monitoring, limiting this program to patients who already have an established relationship with the billing practice. Unlike traditional remote patient monitoring, which involves tracking data collected by devices such as blood pressure monitors or glucose meters, remote therapeutic monitoring pertains to self-reported non-physiological data, such as treatment adherence or pain levels.<\/p>\n
CMS asserted that these changes are part of a broader effort to better connect remote monitoring to the direct clinical relationship between a practice and its patients, rather than allowing it to operate as an outsourced service. <\/p>\n
The agency is accepting public comments on the proposed rule for a period of 60 days, with a final version expected later this year prior to the implementation date of January 1.<\/p>\n
Photo: Vadym Pastukh, Getty Images<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the…<\/p>\n","protected":false},"author":1,"featured_media":2268,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-2267","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-technologie"],"_links":{"self":[{"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/posts\/2267","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/comments?post=2267"}],"version-history":[{"count":1,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/posts\/2267\/revisions"}],"predecessor-version":[{"id":2269,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/posts\/2267\/revisions\/2269"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/media\/2268"}],"wp:attachment":[{"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/media?parent=2267"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/categories?post=2267"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naturalhealthcontent.com\/index.php\/wp-json\/wp\/v2\/tags?post=2267"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}