CMS Proposes to Restrict Outsourced Remote Monitoring Services Under Medicare

Short summary

CMS proposes restricting Medicare payment for remote physiologic and therapeutic monitoring services performed by contractor personnel, requiring employed clinical staff under general supervision. The proposed rule also reduces RPM/RTM service valuations and solicits comment on bundling existing CPT codes into new HCPCS G-codes. If finalized, practices outsourcing monitoring must restructure workflows or transition to technology-only vendor arrangements by January 2027.

• •CMS proposes employed-staff requirement, established-patient rule, and initiating visit for RPM/RTM billing
• •HHS-OIG found 43% of RPM enrollees did not receive all required service components; 2024 payments exceeded $500M
• •Practices outsourcing clinical monitoring would need to bring staff in-house or shift to tech-only vendor deals

Generated with AI, which can make mistakes.