Beginning January 1, 2026, UnitedHealthcare (UHC) will dramatically narrow coverage for Remote Physiologic Monitoring (RPM) across its commercial, Medicare Advantage, and exchange plans....
Artificial Intelligence is currently fractured between two powerful but incompatible paradigms....
If you are billing RPM for Diabetes, Hypertension, or COPD under UHC, your claims will likely be denied starting January 1st....
Originally published at: https://fairpath.ai/resources/cms-rpm-apcm-2025-26 ...
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…...
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…...
In the race to solve complex problems with AI, the default strategy has become brute force: bigger models, more data, larger context windows. We put that assumption to the ultimate test on a critical healthcare task, and the results didn’t just challenge the “bigger is better” m…...
Healthcare is on the brink of a fundamental shift. The forthcoming 2026 CMS Physician Fee Schedule updates are far more significant than mere billing adjustments, they signal a new era in remote care coordination. Practices that adapt early will not only enhance patient care but…...
CMS is quietly reshaping how primary care teams can be paid for mental and emotional health support. Starting in 2026 (if finalized), practices using the new Advanced Primary Care Management (APCM) codes will be able to add small, monthly payments for behavioral health integra…...
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....
On January 1, CMS introduced a brand-new benefit called Advanced Primary Care Management (APCM), a monthly payment designed to roll up the core elements of care coordination under a single code. For primary care leaders, this changes the landscape in profound ways. APCM overlaps…...
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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…...
Primary care is carrying more risk, more responsibility, and more expectation than ever. The opportunity is that we finally have a model that pays for the work most teams already do between visits. The risk is jumping into tooling and tactics before we agree on the basics. Advan…...
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…...
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....
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…...
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…...
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…...
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…...