Operational guidance and analysis for APCM, RPM, RTM, and value-based care execution.
OIG's new CCM audit focus shows why practices and pharmacy partners need pre-claim intelligence that connects eligibility, care plans, evidence, overlap checks, and billing readiness before claims go out.
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Florida is investigating whether CVS/Caremark is using its vertically integrated PBM and pharmacy position to steer patients, pressure reimbursement, impose audits, and harm independent local pharmacies.
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For years, Physician Fee Schedule (PFS) rates were set using data from office-based practices. Starting in 2026, CMS will now use auditable cost data from Hospital Outpatient Departments (OPPS) to set the rates for some PFS technical services, explicitly in...
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If you manage an RPM program, you already know about the 16-day rule. What you may not know is that the workaround some billing teams use to deal with non-compliant patients - pausing the billing cycle until the patient starts transmitting again - creat...
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CMS has fused APCM eligibility, practitioner attribution, and continuity into a single monthly operating system. Billing without that coherence now creates denial and audit exposure. If you are treating these as three separate checkboxes, you are already be...
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With 10 days left in the year, practices were bracing for a major UnitedHealthcare shift: a new RPM medical policy that would sharply narrow coverage to two indications and label most other RPM use as "unproven." Then UHC said it is postponing implementatio...
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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. The 16-day requirement - the patient must transmit data on at least 16 separate days within a 3...
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CMS permanently adopted virtual direct supervision for services furnished after December 31, 2025. That sounds like a green light for remote care management, but it is narrower than most practices think. It changes where the supervisor can be, not what can...
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If your RPM, CCM, or RTM vendor is charging a percentage of collections, you may have a federal fraud-and-abuse problem that neither of you is talking about. It is the most common vendor pricing model in remote care, and it is structurally the hardest to de...
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If you are running APCM, RPM, RTM, and behavioral health add-ons in the same practice, month-end billing is where most of the money leaks happen. Not because the codes are wrong, but because the overlap rules are complex enough that even experienced billers...
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Independent pharmacies are being told they need to "diversify revenue." The default answer from industry consultants is telepharmacy - remote dispensing to underserved areas. That is a real business, but it is not the same business as clinical services re...
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Eating disorders are not just a behavioral health problem. They are a chronic medical condition that requires ongoing primary care coordination, medical monitoring, medication review, nutrition support, family communication, and escalation planning. If your...
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We loaded the newly released HHS Medicaid provider spending file into FairPath and analyzed Remote Physiological Monitoring (RPM) codes. Here are the geographic hotspots and billing patterns that stood out.
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RTM is one of the cleanest ways for pharmacies to build a reimbursable clinical services line because medication adherence is already your surface area. This guide explains what RTM is, how it differs from RPM, and how to run an adherence program at scale without manual cleanup.
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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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By Justin Brochetti, CEO of Intelligence Factory & FairPath | January 20, 2026 Originally Published: https://fairpath.ai/resources/apcm-reporting
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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
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 →