By Matt Fisher, Healthcare Attorney
LinkedIn: Matthew Fisher
X: @matt_r_fisher
Host of Healthcare de Jure – #HCdeJure
The Centers for Medicare and Medicaid Services (CMS) released its proposed 2027 Physician Fee Schedule for Medicare (the 27 PFS) on July 14, 2026. The 27 PFS contained a pretty big surprise: a complete shift in approach to the two primary modes of remote monitoring: remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM).
The Proposal
The long and short of the proposal would be limiting who can RPM and RTM services to only clinical staff employed by the practice employing the clinician that ordered the patient to receive RPM or RTM. It will not be possible to delegate any of the services, including engagement, monitoring, and oversight, to outside third parties under the proposed 27 PFS.
As explained in the proposed 27 PFS, CMS states that RPM and RTM services may currently be outsourced to companies that have little to no connection with the patient and will only deliver the services solely by telephone or online connection. CMS also asserted that the outsourced staff may have little or no interaction with the other members of the care team connected with the ordering clinician.
CMS also referred to recent reports by the Office of the Inspector General for the Department of Health and Human Services (“OIG”) that dove into RPM in particular. As very briefly summarized by CMS in the proposed 27 PFS, it is asserted that the OIG raised concerns about patients receiving cold calls to be enrolled in RPM or RTM services that the patient may not necessarily require. CMS also stated that outsourced services can lead to fragmented care since only loose associations with the ordering clinician are established.
Finally, CMS claims that the loose association between the ordering clinician and the outsourced RPM or RTM company does not result in sufficient oversight, management, and collaboration to fulfill all of the requirements under the associated billing codes. Reading between the lines on that comment, CMS seems to state that there is a lot of fraud occurring with RPM and RTM services, but does not cite specific data on that front. Recalling the OIG report, the OIG raised concerns that RPM could result in fraud if not appropriately monitored, but also did not clearly find that there were a lot of actual instances of fraud that could be held up as examples.
RPM and RTM Market
The proposed arguable wholesale restructure of how RPM and RTM work would significantly shake up the industry. There are any number of companies for RPM and/or RTM that offer so-called turnkey services to enable the delivery of RPM and RTM. The turnkey approach is for the vendor to have a technology platform, permissible monitoring devices, and staff (typically below the ordering clinician level) to work with the patients and generate the engagement and data needed to provide RPM and RTM. The vendor in essence enables its client (the ordering clinician) to provide RPM and/or RTM services by extending capabilities.
Why is a turnkey approach needed? The general argument for the turnkey approach is that existing staff in practices are too resource and time strapped to add in more services that do require a fair amount of investment to deliver all of the components that support billing. The turnkey approach, as it is often sold, just requires the ordering clinician to initiate the service and then everything else is handled with the package wrapped up for the ordering clinician to bill for the service.
Some vendors will ask for a full patient roster from the client to kick off patient outreach. Sales claims may assert that pretty much every patient will be eligible for RPM and/or RTM services and that in turn can produce a very rosy picture of “found” revenue for the ordering clinician. That is a very simplistic boiling down of the sales pitch, but it is certainly an approach that can happen frequently. That approach is certainly what caught the attention of the OIG to claim that RPM and RTM can be ripe for fraud since it is seen as a form of a patient mill.
Beyond the sales pitch, the vendor could potentially play a bit fast and loose with the data collection requirements and review of that data. The ability to feed data to the ordering clinician can also be spotty. For example, is the collected data actually written into the ordering clinician’s electronic medical record (“EMR”) or only a summary report delivered in pdf or other format? The answer to that question is usually not driven by the vendor, but the ordering clinician’s practice or organization. Far too often direct integration with the EMR does not occur, which results in the ordering clinician having to access yet another system or receiving data that cannot be easily interacted with. While this is an impact on the delivery of RPM and RTM services, it is not the faut of the vendor.
All of that quick summary is a high level overview of how RPM and RTM services are pitched and attempted to be implemented. It can all sound very good, but the reality is often far different. The scope of patients enrolled does not match the hype and the “extra” revenue is not that great. Keeping patients engaged and consistently providing all of the needed information is hard to achieve. In fact, there have been rumblings in the past couple of years that the RPM and RTM codes should be adjusted to reduce the number of readings required as the original baseline may actually exceed what is clinically necessary. It just means that RPM and RTM have not necessarily achieved the promise they were initially viewed to hold.
A final note about the current setup is that there are some vendors out there that will seek full referral of the patient. A full referral means the patient’s regular clinician will send the patient to the vendor for delivery and reimbursement of the RPM and RTM services with the vendor. That can occur because this class of vendor also employs clinicians that can order and bill for RPM and RTM services. That means the patient is introduced to a completely new clinician and has to establish a relationship with that clinician for the services to become billable. Arguably, this also can lead to fragmentation because now the clinician at the vendor does not clearly have a connection with the original clinician and/or an incentive to share information back. Instead, there is just a referral for the additional services.
Considerations about the State of Affairs
Between the position being staked out by CMS and the realities being seen in the wild, there are a lot of questions that remain to be answered. One of the vital questions is whether RPM and/or RTM are viable services that are sustainable. There is clearly value and benefit to be derived from both sets of services as they can lead patients to improved overall health and outcomes. The delivery mechanisms may not yet be ideally lined up for that promise. That is the rub, although swinging too far in either direction is likely not the answer.
The arguable lines in the sand coming from CMS are interesting given the ACCESS Model that CMS just launched. The ACCESS Model hinges on remote monitoring and interestingly (or conveniently) the delivery path is for full referral of patients to the vendor providing the remote monitoring services. Cynically, is the proposed 27 PFS a way to drive companies in the direction called for by the ACCESS Model and/or to clear the playing field to indirectly support that ACCESS Model? That is admittedly a rampant bit of speculation, but it is not overly hard to see those connections.
Another practical consideration, hinted at above, is that the promise and hype of RPM and RTM have yet to be fulfilled. It used to be (and likely can still be) that companies would have pie in the sky numbers of additional revenue that could be generated by getting so many patients enrolled in the services. Many websites could be found touting the opportunity to generate millions of extra revenue. That has not materialized and also frames the discussion in purely economic terms as opposed to the benefit for patients that comes from getting a better handle on chronic matters.
The other overarching issue that keeps coming up is whether RPM and/or RTM is driving fraud. It does not seem there is solid data to back up the fears other than the impression that potentially unnecessary services are occurring. It is also possible to use the puffery based claims to support fears of fraud because the sales claims all seemed premised on driving revenue without looking at the details. It is a bit unfair to target an entire line of service over the fear of fraud without clear evidence that it is happening. Further, even if fraud is present (and there are always bad actors in every component of healthcare), taking a potential sledgehammer to a line of service is not necessarily the answer. Other mechanisms exist that could be exercised first to tackle the potential problem before a wholesale alteration. The retrenchment represented by the action also reverses recent movement around the codes from to make the services better aligned with better clinical practice.
What To Do
The proposed 27 PFS is just a proposal at this point in time, which makes it important to submit comments in response to the positions that CMS is staking out. The process of promulgating regulations is an ideal way for many to have their voice heard and inform what actions are taken by the regulatory agency. It is a direct way to influence policy and one that can be done from anywhere. Regardless of viewpoint, anyone who is interested in the future of RPM and RTM should take the time to participate.
With that in mind, the industry will now likely wait with bated breath until the late fall when the final fee schedule is published.
This article was originally published on The Pulse blog and is republished here with permission.