- September 30, 2024
- Alerts
Remote Patient Monitoring Under the Microscope
The U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) released a Report outlining concerns about the rapid growth of and significant oversight gaps in the Centers for Medicare & Medicaid’s (“CMS”) use of remote patient monitoring (“RPM”) services, particularly with traditional Medicare patients (the “Report”). Given RPM’s dramatic growth, especially since the COVID-19 pandemic, the Report likely foreshadows OIG enforcement actions in this area.
Broadly, CMS covers RPM (also known as “remote physiologic monitoring”) of health data for any chronic or acute condition. Patients collect their own health data (e.g., blood pressure, weight, glucose or blood oxygen levels, respiratory flow rate, etc.) using an approved, internet-connected medical device to transmit this data to their provider. The provider then uses the data to treat or manage the patient’s condition. Providers billing RPM services use a general set of procedure codes to reflect three key components: (1) education and setup; (2) device supply; and (3) treatment management.
The Report identifies several vulnerabilities that increase the risk of RPM fraud, waste, and abuse, such as a lack of information about the:
Additionally, OIG found that approximately 43 percent of enrollees who received RPM services did not receive all three components of it – either education and setup, device supply, or treatment management. These omissions raise questions about whether providers are using RPM as CMS intended.
The Report also included several recommendations to CMS focused on implementing additional safeguards to ensure that providers use and bill RPM services appropriately, such as: entering the identity of the ordering provider on claims and encounter data; educating providers about billing RPM services; and improving data collection and tracking efforts, as well as identifying and monitoring companies that bill for RPM.
Providers and companies rendering RPM services should expect increased scrutiny from OIG and CMS as a result of the Report. As such, providers and companies are strongly encouraged to conduct a proactive, comprehensive review of their RPM programs to ensure compliance with CMS’s service delivery, documentation, and billing guidelines. Given CMS’s increasing focus on RPM services, now is a good time to contact us to assess your compliance with these requirements.
A complete copy of the Report is available here.
Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or email us at info@garfunkelwild.com.
Broadly, CMS covers RPM (also known as “remote physiologic monitoring”) of health data for any chronic or acute condition. Patients collect their own health data (e.g., blood pressure, weight, glucose or blood oxygen levels, respiratory flow rate, etc.) using an approved, internet-connected medical device to transmit this data to their provider. The provider then uses the data to treat or manage the patient’s condition. Providers billing RPM services use a general set of procedure codes to reflect three key components: (1) education and setup; (2) device supply; and (3) treatment management.
The Report identifies several vulnerabilities that increase the risk of RPM fraud, waste, and abuse, such as a lack of information about the:
- providers ordering or delivering RPM services;
- diseases/conditions or types of health data being monitored; and
- types of devices enrollees use.
Additionally, OIG found that approximately 43 percent of enrollees who received RPM services did not receive all three components of it – either education and setup, device supply, or treatment management. These omissions raise questions about whether providers are using RPM as CMS intended.
The Report also included several recommendations to CMS focused on implementing additional safeguards to ensure that providers use and bill RPM services appropriately, such as: entering the identity of the ordering provider on claims and encounter data; educating providers about billing RPM services; and improving data collection and tracking efforts, as well as identifying and monitoring companies that bill for RPM.
Providers and companies rendering RPM services should expect increased scrutiny from OIG and CMS as a result of the Report. As such, providers and companies are strongly encouraged to conduct a proactive, comprehensive review of their RPM programs to ensure compliance with CMS’s service delivery, documentation, and billing guidelines. Given CMS’s increasing focus on RPM services, now is a good time to contact us to assess your compliance with these requirements.
A complete copy of the Report is available here.
Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or email us at info@garfunkelwild.com.