Operational guidance and analysis for APCM, RPM, RTM, and value-based care execution.
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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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Beginning January 1, 2026, UnitedHealthcare (UHC) will dramatically narrow coverage for Remote Physiologic Monitoring (RPM) across its commercial, Medicare Advantage, and exchange plans.
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If you are billing RPM for Diabetes, Hypertension, or COPD under UHC, your claims will likely be denied starting January 1st.
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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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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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Remote Patient Monitoring (RPM) has rapidly evolved from emerging healthcare innovation into a strategic necessity. Driven aggressively by CMS reimbursement policies, RPM adoption has accelerated at unprecedented rates, reshaping market dynamics and creating compelling strategic…
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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.
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Let’s be honest. Managing your health today feels like trying to coordinate a group project where nobody checks their messages. Your cardiologist, endocrinologist, and PCP are all working on the same assignment, but nobody’s sharing notes. The result? Confusion, overlap, and som…
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In my work with healthcare organizations across the country, I see two distinct patient profiles coming into focus. They represent the past and future of remote care, and every successful practice must now build a bridge between them. The first is the patient for whom technology…
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It starts with a data spike… a sudden drop in movement, a rise in reported pain. The alert pings the provider dashboard, hinting at deterioration. But what if that signal isn’t telling the whole truth?
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Chronic pain isn’t just a condition, it’s a thief. It steals time, joy, and freedom from over 51 million Americans, according to the CDC, costing the economy $560 billion a year. As someone passionate about healthcare innovation, I’ve seen how this silent struggle affects patien…
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The Office of Inspector General’s (OIG) 2024 report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260) , isn't just an alert—it's a detailed playbook exposing critical vulnerabilities in Medicare’s Remote Patient Monitoring (RPM) system. R…
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 →