Medicare remote care policy
Remote care policy for care at home
HealthEverywhere tracks the Medicare, CMS, HHS, OIG, and AI oversight decisions shaping remote patient monitoring, telehealth, and care-at-home models.
Policy intelligence for remote care
Use HealthEverywhere as a fast entry point into the federal policy signals that affect remote monitoring, virtual care, home-based care delivery, and emerging AI oversight.
Medicare
Remote care rules
Coverage, billing, documentation, consent, and oversight issues for RPM, RTM, telehealth, and home-based care.
Policy Watch
What changed and why it matters
Source-linked updates on CMS, HHS, OIG, Congress, Medicare Advantage, and care-at-home policy changes.
AI Watch
AI in remote monitoring
How algorithms, prior authorization, device data, FDA oversight, and bias risks are changing remote care policy.
Latest policy signals
Recent posts are organized around practical reader questions: what changed, who is affected, and where to verify the primary source.
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FY 2027 Medicare Hospital Inpatient and LTACH Payment Rates and Policy Updates
This final rule will revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; make changes relating to Medicare graduate medical education (GME) for teaching hospitals; update the payment policies and the annual payment rates for the…
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FY 2027 Medicare Hospice Wage Index and Payment Rate Updates
This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. This final rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index, and finalizes the requirement that hospices provide the…
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FY 2027 Medicare Inpatient Rehab Payment Rates and Quality Reporting Updates
This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2027. As required by statute, this final rule includes the classification and weighting factors for the IRF prospective payment system’s (PPS) case-mix groups and a description of the…
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Medicare Updates to Face-to-Face Encounter and Prior Authorization Lists
This document announces updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Master List. It also announces updates to the HCPCS codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List.
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CY 2027 Medicare Physician Fee Schedule and Part B Payment Updates
This proposed rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the…
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CMS Seeks Public Input on CLIA Regulation Updates
Clinical laboratory testing technology has advanced significantly since the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations were implemented in 1992. This request for information (RFI) seeks input from the public regarding various topics related to the CLIA regulations, including: breath testing;…
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FY 2027 Medicare Outpatient Hospital and ASC Payment Rates
This proposed rule would revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2027 based on our continuing experience with these systems. We also describe the changes to the amounts and factors used to determine the…
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CY 2027 Medicare Home Health Payment Rates and V-BP Model Expansion
This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule discusses the behavior adjustment and proposes a temporary behavior adjustment and proposes to recalibrate the case-mix weights…
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How AI Is Changing the Alerts That Keep Medicare Patients Out of the Hospital
Remote patient monitoring was once a simple data-collection exercise — a blood pressure reading transmitted, a nurse alerted if the number crossed a threshold. Artificial intelligence is fundamentally changing that model, shifting from reactive alerts to individualized predictive risk scoring that can flag deterioration before any vital sign crosses a static cutoff. From thresholds to…
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The Bias Problem in AI-Assisted Remote Monitoring: What CMS and the FDA Still Haven’t Fixed
As AI-driven remote patient monitoring scales across Medicare, a critical question remains unanswered: are these algorithms working equally well for everyone? Research published in 2026 confirms that AI models built on decades of unequal healthcare utilization data can replicate and amplify those inequities — producing less accurate risk alerts for low-income, rural, and minority patients…
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UnitedHealthcare Tried to Cancel Remote Monitoring for Most Medicare Patients. Here’s Why It Matters.
In late 2025, UnitedHealthcare announced it would stop covering remote patient monitoring for nearly all conditions starting January 1, 2026 — including chronic hypertension, diabetes, and COPD — affecting millions of Medicare Advantage members. The policy would have limited RPM coverage to only heart failure and pregnancy hypertension patients. The backlash was immediate. Two weeks…
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CMS WISeR Model Uses AI-Assisted Review for Selected Medicare Prior Authorization Requests
Since January 1, 2026, Medicare patients in six states have had their care requests evaluated by an AI system called WISeR — the Wasteful and Inappropriate Service Reduction model, a CMS pilot active in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The program screens Medicare prior authorization requests for services deemed “low-value,” and it…
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Telehealth Is Extended Again. But ‘Extended’ Is Not the Same as ‘Permanent.’
Medicare telehealth survived another near-death experience in early 2026. When a 42-day government shutdown caused COVID-era telehealth waivers to briefly lapse, research from Brown University documented a 24% drop in telemedicine visits in just the first two weeks. Congress responded with a retroactive two-year extension through December 31, 2027, passed as part of a February…
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Rural Medicare Patients Get the Worst RPM Reimbursement in the States That Need It Most
A structural inequity built into Medicare’s reimbursement formulas penalizes remote patient monitoring in the places where chronic disease burden is highest and specialist access is lowest. The geographic payment index used to calculate RPM reimbursement means providers in Mississippi and Arkansas receive approximately $84–$85 per enrolled patient per month, while the national average is $96…
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CMS updates Medicare remote patient monitoring guidance
Source: Centers for Medicare & Medicaid Services CMS updated its Medicare remote patient monitoring page, describing RPM components, eligibility, coverage, billing structure, and fraud-prevention expectations. Why it matters: This is a core reference page for Medicare RPM policy and should be checked before relying on older billing summaries. HealthEverywhere note: This post is a source-linked…
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Medicare Telehealth Coverage, Coding and Billing Resources
CMS’s Medicare telehealth hub: coverage and payment policy, the list of telehealth services payable under the Physician Fee Schedule, and billing and coding resources for providers.
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CMS refreshes Medicare telehealth policy page and FAQ links
Source: Centers for Medicare & Medicaid Services CMS refreshed its Medicare telehealth page, reiterating that additions and deletions to the Medicare Telehealth Services List are made through the annual physician fee schedule process. Why it matters: Telehealth access continues to depend on rulemaking, statutory authority, and the Medicare Telehealth Services List. HealthEverywhere note: This post…
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CMS posts the 2026 Medicare Telehealth Services List
Source: Centers for Medicare & Medicaid Services CMS posted the list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth for calendar year 2026. Why it matters: The services list is one of the most important operational references for Medicare telehealth coverage. HealthEverywhere note: This post is a source-linked policy news…
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Latest Medicare Telehealth Policy Changes
Telehealth services can be provided by all eligible Medicare providers through December 31, 2027.
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CMS finalizes CY 2026 Home Health Prospective Payment System rule
Source: Centers for Medicare & Medicaid Services CMS issued the CY 2026 Home Health PPS final rule, updating Medicare payment policies for home health agencies. Why it matters: Remote care policy should be read alongside home-health payment policy because care-at-home models depend on aligned payment and quality rules. HealthEverywhere note: This post is a source-linked…
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CMS finalizes CY 2026 Physician Fee Schedule telehealth and remote monitoring policies
Source: Centers for Medicare & Medicaid Services CMS finalized CY 2026 Physician Fee Schedule policies affecting telehealth, virtual direct supervision, RHC/FQHC telecommunication services, and rate-setting for some remote monitoring services. Why it matters: The annual PFS rule is the main policy vehicle for many Medicare telehealth and remote monitoring changes. HealthEverywhere note: This post is…
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HHS OIG reports Medicare remote patient monitoring payments exceeded $500 million in 2024
Source: HHS Office of Inspector General HHS OIG reported that Medicare RPM use continued to grow in 2024, with payments exceeding $500 million, and described billing measures that can identify practices warranting further scrutiny. Why it matters: The report highlights the policy tension between expanding remote care access and maintaining program-integrity safeguards. HealthEverywhere note: This…
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OIG Data Brief: Billing for Remote Patient Monitoring in Medicare
The use of remote patient monitoring continued to grow in 2024, with Medicare payments exceeding $500 million. OIG developed measures to monitor RPM billing as a safeguard against fraud, waste, and abuse.
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CMS publishes provider education on using and billing remote patient monitoring correctly
Source: Centers for Medicare & Medicaid Services CMS pointed providers to updated education on correctly using and billing remote patient monitoring after OIG recommended additional oversight. Why it matters: Provider education is a direct response to RPM oversight concerns and helps clarify billing expectations. HealthEverywhere note: This post is a source-linked policy news summary. Readers…
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CMS finalizes CY 2025 Physician Fee Schedule telehealth policies
Source: Centers for Medicare & Medicaid Services CMS finalized CY 2025 PFS policies preserving selected telehealth flexibilities, including audio-only availability for certain home telehealth services and extended telecommunication-technology payment policies for RHCs and FQHCs. Why it matters: The rule shaped the transition from pandemic-era flexibilities toward longer-term Medicare telehealth policy. HealthEverywhere note: This post is…
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CMS issues transmittal allowing home health telehealth services during an inpatient stay
Source: Centers for Medicare & Medicaid Services CMS issued transmittal R12888CP on allowing home health telehealth services during an inpatient stay, with implementation scheduled for April 7, 2025. Why it matters: This is a narrow but practical operational change for providers coordinating home health and inpatient care. HealthEverywhere note: This post is a source-linked policy…
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HHS OIG calls for additional oversight of Medicare remote patient monitoring
Source: HHS Office of Inspector General HHS OIG found Medicare RPM use increased dramatically from 2019 to 2022 and recommended stronger safeguards, clearer ordering information, provider education, and monitoring of billing companies. Why it matters: This report is foundational for understanding current program-integrity concerns around RPM. HealthEverywhere note: This post is a source-linked policy news…
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OIG Calls for Enhanced Medicare RPM Oversight
What OIG Found: Taken together, our findings demonstrate the need for additional oversight to ensure that remote patient monitoring is being used and billed appropriately.
What we track
HealthEverywhere focuses on the operational policy topics that determine whether remote care becomes durable, accountable, and accessible.
RPM and RTM
Coverage, device data, time, consent, clinical use, and billing clarity.
Telehealth access
Permanent authority, service lists, originating site rules, and audio-only policy.
AI oversight
Prior authorization, algorithmic bias, FDA software policy, and patient trust.
Program integrity
Documentation, supplier relationships, billing patterns, audits, and OIG findings.
Need the primary sources?
The resources page collects CMS, HHS, OIG, and federal policy references for Medicare telehealth, remote monitoring, and care-at-home issues.