Operational guidance and analysis for APCM, RPM, RTM, and value-based care execution.
Independent pharmacy owners are being asked to run a real business on economics that do not behave like a real business.
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You've likely caught the buzz on X and news feeds about President Trump's "The Great Healthcare Plan" framework, released today (January 15, 2026). Per the official White House fact sheet, it calls for insurers to publish "plain-English" comparisons of rates, coverage, denial ra…
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On December 29, 2025, CMS announced $50 billion in Rural Health Transformation (RHT) awards across all 50 states. This is a five-year initiative with $10 billion available each year from 2026 through 2030.
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Anthem has quietly made an important update to its clinical policy CG-MED-91 , effective December 18, 2025. The change aligns Anthem with CMS’s 2026 Physician Fee Schedule and formally recognizes the new “short-cycle” Remote Physiologic Monitoring (RPM) and Remote Therapeutic Mo…
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Originally published at: https://fairpath.ai/resources/uhc-postpones-2026-rpm-rollback
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If you run an independent practice, rapid RPM growth probably still feels like a win.
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If you manage a Remote Physiological Monitoring (RPM) program, CPT code 99454 is likely your biggest source of revenue and, also likely, your biggest headache. This code, which reimburses for the supply of the device and data transmission, has long carried a notorious "all-or-no…
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Most independent practices didn’t launch remote care programs so they could track timers, chase scattered documentation, or argue with spreadsheets at the end of every month. They adopted RPM and CCM because they believed these programs would keep patients out of the hospital, c…
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Over the past several years, I’ve heard it all. Remote patient care is a scam. It doesn’t work. RPM is designed to fail. I’ve listened to the frustrations from doctors, managers, and administrators who swear that remote care is nothing but another profit scheme wrapped in good i…
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The CMS 2026 Physician Fee Schedule updates reshape how remote care coordination can be staffed, supervised, and reimbursed. Here’s what changed and how to operationalize it.
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If your practice adopted APCM by shutting down RPM and RTM programs, you left money on the table. If you're running all three programs separately, you're burning cash on duplicate documentation and exposing yourself to compliance risk.
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Advanced Primary Care Management (APCM) represents one of the more meaningful changes in the CMS Physician Fee Schedule. As of January 1, 2025, practices that adopt this model will be reimbursed through monthly, risk-stratified codes rather than only episodic, time-based billing…
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The Federal Trade Commission’s Sept. 12 warning to healthcare employers is a simple message with real operational consequences. Overbroad noncompetes, no‑poach language, and “de facto” restraints chill worker mobility and can limit patients’ ability to choose their clinicians. F…
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Advanced Primary Care Management represents Medicare's most ambitious attempt to transform primary care economics. Unlike previous programs that nibbled at the margins, APCM fundamentally restructures how practices organize, deliver, and bill for comprehensive care.
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Advanced Primary Care Management (APCM) is Medicare’s newest program, introduced in 2025 with three billing codes: G0556, G0557, and G0558. This represents a pivotal shift toward value-based primary care by offering monthly reimbursements for delivering continuous, patient-focus…
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At 2 AM, a new mother in rural Alabama feels her heart racing. She's two weeks postpartum, alone with a newborn while her husband works the night shift. Her blood pressure reading on the home monitor shows 158/95. Within minutes, her care team receives an alert. By 6 AM, a nurse…
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Many health systems pay $40–$80 per patient per month (PMPM) for full-service remote patient monitoring while Medicare's 2025 national averages reimburse approximately $91–$129 monthly depending on engagement time. When clinical teams can deliver the same services internally, th…
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A few months ago, a physician at a 12-doctor practice in rural California called me frustrated. His practice was hemorrhaging money on readmissions, his nurses were burning out from phone tag with chronic disease patients, and his administrator was getting pressure from their he…
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Medical executives today face an uncomfortable reality: while navigating shrinking margins and mounting operational pressures, many are unknowingly surrendering millions in Medicare reimbursements to third-party vendors. The culprit? Poorly structured Remote Patient Monitoring (…
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If you've spent any time managing a remote patient monitoring (RPM) program, you already know the drill: juggling the 16-day rule, keeping track of clinical minutes, chasing compliance, and often wondering if this is really what patient-centered care was meant to feel like.
Read MoreFairPath is built on operational work, not theory. We publish the playbooks and checklists we use to keep programs compliant and profitable. Use them whether you run FairPath or not.
Browse the Expert Library →The practical 2026 guide to device rules, day thresholds, management time, and audit defensibility for Remote Patient Monitoring.
Read the RPM Guide →How to run Remote Therapeutic Monitoring for MSK, respiratory, and CBT workflows with the correct 9897x and 9898x rules.
Read the RTM Guide →Calendar-month operations for CCM: consent, initiating visit, care plan requirements, time counting, and concurrency rules.
Read the CCM Guide →The operator blueprint for Advanced Primary Care Management: eligibility, G0556–G0558 tiers, and monthly execution.
Read the APCM Playbook →