A September 24 report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) exploring the use of remote patient monitoring (RPM) in the Medicare population finds that additional oversight is needed to ensure proper use of and billing for RPM.
During the pandemic, RPM increased dramatically. About 43% of enrollees who received RPM did not receive all three components, (enrollee education and device setup, device supply of information, and treatment management) raising questions about whether the monitoring is being used as intended.
Concerns about fraud in RPM have been raised by both CMS and OIG previously. Medicare lacks key information for oversight, including who ordered the monitoring for the enrollee and who is monitoring the device under the ordering clinician’s identifier, the OIG says. In one instance, a single provider billed 23,569 hours of treatment management for RPM in 2022, far more hours than the 8,760 hours in a year. While many post-acute providers including home health and hospice cannot bill for RPM, many individuals in independent living and assisted living have these devices ordered by clinicians. In 2023, OIG issued a consumer advisory regarding RPM fraud. The OIG made the following recommendations to CMS, who concurred and will take into consideration:
- Implement additional safeguards to ensure that remote patient monitoring is used and billed appropriately in Medicare.
- Require that remote patient monitoring be ordered and that information about the ordering provider be included on claims and encounter data for remote patient monitoring.
- Develop methods to identify what health data are being monitored.
- Conduct provider education about billing of remote patient monitoring.
- Identify and monitor companies that bill for remote patient monitoring.
