Athelas, a health care technology firm, recently expanded its services to include remote patient monitoring (RPM) as part of its growing portfolio. Introduced in 2020, the aim was to support clinics in recruiting patients for remote monitoring and managing the subsequent billing process. However, this expansion has attracted unwanted attention due to allegations of complex and potentially inappropriate billing practices. At the heart of the issue is adherence to the Centers for Medicare & Medicaid Services (CMS) guidelines that dictate the operation and billing of RPM services.According to CMS rules, RPM devices must actively gather and transmit health data for a minimum of 16 days within a 30-day period to qualify for insurance reimbursement. This specific requirement is designed to limit reimbursement to cases where the devices are genuinely active and providing ongoing monitoring of a patient’s health. The scrutiny arises from doubts as to whether Athelas has consistently met these strict CMS criteria when billing for its RPM services.
Navigating Compliance and Industry Standards
Athelas, a health care tech company, broadened its offerings in 2020 to include remote patient monitoring (RPM), aiming to assist clinics with patient enrollment and billing for remote health services. This move has sparked controversy over billing practices that may not align with the strict guidelines set by the Centers for Medicare & Medicaid Services (CMS). These guidelines mandate that RPM devices must record and send health data for at least 16 days within any given 30-day period to be eligible for reimbursement. Concerns have emerged about Athelas potentially billing for RPM services without fully meeting the CMS’s rigorous monitoring requirements. This scrutiny highlights the critical balance RPM providers must maintain between innovation in patient care and compliance with healthcare regulations.
