Remote patient monitoring (RPM) uses digital devices to monitor a patient’s health which allows patients and providers the ability to manage acute and chronic conditions by collecting and sharing health information. RPM devices transmit patient health information to providers without requiring an in-office presence – and who doesn’t want to avoid unnecessary office visits just for collecting routine health information? RPM is widely used for chronic disease management since many of those conditions are best supported by consistent data points that drive care planning. RPM programs have minimum enrollment requirements: the enrollee must have a chronic or acute condition; RPM must be conducted with an internet-connected device approved by the Food and Drug Administration (“FDA”) and RPM must collect and transmit a minimum amount of data within 30 days.
RPM Over the Years
Between 2019 and 2022, the number of Medicare recipients receiving remote patient monitoring increased 10-fold, and billing for RPM increased 20-fold[1]. And in 2023, the Department of Health and Human Services Office of Inspector General (HHS-OIG) issued a consumer alert related to RPM[2]. The use of RPM continued to grow in 2024 and has the potential to greatly expand in the future. If you haven’t seen it yet, check out the OIG’s August 2025 Data Snapshot regarding Billing for RPM in Medicare[3].
What to look for
RPM can be big business for improper billing. Its rapid growth has created environments that are more at risk for overpayments. So how do you protect yourself? Well, first you must understand what it all means. RPM includes both remote physiological monitoring (blood pressure, blood sugar, oxygen saturation, blood oxygen levels, weight loss or gain) and remote therapeutic monitoring (non-physiological data, often self-reported, related to therapeutic treatment). RPM uses a general set of procedure codes that represent the three different components of the monitoring enrollees receive (i.e., education and setup; device supply; and treatment management).
HCFS has you Covered
Combating improper billing in RPM services requires a multi-pronged approach. Payers need to leverage advanced data analytics to identify suspicious billing patterns and inappropriate number of services. If you’re using the HCFSPlatform™, we’ve got you covered. Our Artificial Intelligence (AI) models identify spikes and other anomalous and emerging billing patterns. Additionally, targeted and outlier analysis identifies concerns in RPM. And we are adding new alerts each month. Some examples include:
[2432-20] – SPIKE IN REMOTE PATIENT MONITORING (RPM)
[2566-01] – INAPPROPRIATE SERVICES, REMOTE PHYSIOLOGIC MONITORING (RPM) TREATMENT MANAGEMENT SERVICES BILLED WITH E/M VISITS
[2568-01] – INAPPROPRIATE UNITS, MULTIPLE PHYSICIANS BILLING RPM SERVICES FOR THE SAME PATIENT
[2567-20] – OUTLIER, REMOTE PHYSIOLOGIC MONITORING (RPM) TREATMENT MANAGEMENT SERVICES ADD-ON CODE
[1] https://www.hipaajournal.com/hhs-oig-increase-oversight-remote-patient-monitoring/
[2] https://oig.hhs.gov/fraud/consumer-alerts/consumer-alert-remote-monitoring/
[3] https://oig.hhs.gov/documents/evaluation/10901/OEI-02-23-00261.pdf
If you’re not using the HCFSPlatform™ and you’re interested in knowing more, email us at [email protected].
If you have questions or comments, you may email us at [email protected].
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