On September 24, 2024, the U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) posted a report entitled, “Additional Oversight of Remote Patient Monitoring in Medicare is Needed.”
The OIG found that Medicare usage of remote patient monitoring has increased significantly in recent years, particularly between 2019 and 2022. The most common conditions for which Medicare enrollees received remote patient monitoring services were hypertension (55%) and diabetes (16%). Additionally, remote patient monitoring was most commonly provided by primary care (59%) and cardiology (11%) providers. The OIG also determined that approximately 43% of the Medicare enrollees analyzed in the report who received remote patient monitoring services1 were not provided at least one of the three following components of these services:
- Enrollee education and set up (CPT code 99453)
- Supply of a connected device (CPT code 99454)
- Treatment management (CPT codes 99091, 99457, or 99458)
While the OIG was careful to note that the Centers for Medicare and Medicaid Services (“CMS”) does not necessarily require that providers bill for all three components, it signaled that evidence that a high percentage of enrollees may not have received all components may suggest remote patient monitoring services are not being used as intended. The report expressed that both the OIG and CMS have concerns about fraud and abuse related to remote patient monitoring services.
This report is just the latest indicator signifying remote patient monitoring is an area of increased government interest. In addition, Medicare use of remote patient monitoring remains an open OIG Work Plan item, and CMS recently provided additional clarification regarding Medicare restrictions related to remote physiologic monitoring and remote therapeutic monitoring services in the 2024 Physician Fee Schedule Final Rule. Among other things, the Final Rule reaffirmed that such remote monitoring services should only be furnished to an established patient, confirmed a return to pre-pandemic data collection and transmission requirements of at least 16 days in a 30-day period, and provided additional detail about when remote monitoring may and may not be billed in conjunction with other services.
Thus, Medicare providers that bill for any component of the remote patient monitoring services should expect and prepare for heightened government scrutiny regarding their Medicare billing practices, which may include increased and targeted audit activity.
To read the full report, please click here.
[1] The report focused on claims and encounter records for remote patient monitoring with dates of service from January 1, 2019, through December 31, 2022, billed with one or more remote patient monitoring procedure codes (i.e., Current Procedural Terminology codes: 99091, 99453, 99454, 99457, and 99458).
