A proposta de tabela de taxas da CMS para 2027 poderá proibir o seu fornecedor externo de MTR

Utiliza um modelo de serviço completo para o MTR? Prepare-se para as alterações propostas pelo CMS ao MTR, com vista a salvaguardar as suas receitas.

A CMS (agência federal de saúde dos EUA) propôs uma nova regra para a Tabela de Honorários Médicos do ano civil de 2027. Trata-se de uma proposta, e não de uma política definitiva, mas poderá tornar o modelo de faturamento do seu fornecedor externo de MTR não conforme.

• O MTR seria restrito a pacientes já registrados.
• Seria necessária uma visita inicial presencial antes do início do RPM ou do MTR.
• Os serviços faturáveis limitam aos prestados por profissionais clínicos empregados pela clínica responsável pela emissão da fatura.
• A CMS (agência federal de saúde dos EUA) solicitou comentários sobre a fusão dos atuais 17 códigos CPT RPM/RTM em quatro códigos HCPCS G agrupados.
• Comments are due within 60 days of the July 15, 2026 notice.

The takeaway is simple. If the people monitoring your patients are not employed by your practice, your billing model is at risk under this proposal.

CMS's proposed CY2027 rule and why it lands differently this time

CMS proposed the new rule in a notice covered by the AHCA/NCAL blog, published July 15, 2026. You have 60 days to comment. Nothing is final yet, but the direction is clear.

Você sabia que isso está por vir se administrar um fornecedor terceirizado de serviços completos de monitoramento ou gestão de recursos humanos (MTR)?Muitas clínicas não sabem. O seu fornecedor encarrega-se do pessoal e da monitorização, e a clínica fatura esses serviços. Esse acordo é exatamente o que esta regra visa atingir.

This is not routine fee schedule tinkering. CMS is signaling a broader shift toward simpler, integrated remote monitoring delivered by the billing practice itself. The proposed staffing restriction and the request to bundle 17 codes into four G-codes point the same way. Outsourced monitoring becomes harder to bill, and in-house delivery becomes the compliant path.

O que realmente significa "ser contratado pelo consultório responsável pelo faturamento"

The proposed rule would only pay for remote monitoring when the person doing it works for your practice. That single line decides which staffing models keep billing and which ones stop.

A W-2 employee is the safest fit. If a physical therapist or clinical staff member on your payroll runs the monitoring, you clearly furnished the service through your own practice. A 1099 contractor is less certain. Depending on how the contract is written and how CMS reads "employed," a contractor may or may not count.

An outsourced monitoring vendor is the one most exposed. Full-service vendors run the monitoring with their own staff, not yours. Under this language, that staff is not employed by the billing practice, so the service they perform would not be billable. The problem isn't the CPT codes. It's who does the work. Even a perfectly coded claim fails if the monitoring came from a third party's team instead of your own.

Nada disto é definitivo. A CMS (agência federal de saúde dos EUA) poderá alterar ou retirar esta disposição após o período de consulta pública. No entanto, a orientação é suficientemente clara para ser analisada agora. O resumo da AHCA/NCAL sobre a proposta de regulamento explica a restrição ao número de profissionais e a tendência mais ampla no sentido do monitoramento realizado na prática.

Como os três modelos de contratação se comparam com a regra proposta

A regra proposta privilegia o monitoramento realizado por funcionários contratados pela própria empresa. A tabela abaixo mostra a comparação entre os dois modelos.

The rule points clearly toward the in-house model. When your own employed clinicians do the monitoring, the work stays inside your practice, and the billing holds up under the "employed by the billing practice" language. The outsourced model puts the monitoring staff outside your practice, which is exactly what this proposal treats as non-billable.

What to check in your current RTM vendor contract right now

Pull your RTM vendor contract and read the staffing section first. Find out who actually performs the monitoring and the interactive communication with your patients. If the answer is the vendor's own staff, and those people are not employed by your practice, the proposed rule puts your billing at risk.

Check how the contract defines who "furnishes" the service. Vendors often describe themselves as delivering the monitoring on your behalf. Under CMS's proposed language, that arrangement is the problem, because billable RTM would need to come from clinical staff your practice employs.

Ask your vendor directly whether their monitoring staff are your employees or theirs. Most full-service vendors use their own people, so expect that answer. Get it in writing.

On timing, the rule is a proposal, not final law, so you don't need to break your contract today. Read the AHCA/NCAL summary of the proposed rule and note the comment window during the 60 days after the July 15, 2026 notice. Use this period to map your exposure and line up an alternative. Hold off on any new multi-year outsourcing commitment until you see the final rule.

Preparar um modelo interno em conformidade antes da aprovação definitiva da regulamentação

If your review shows exposure, the fix is to bring monitoring in-house. Have your own W-2 clinical staff, or properly employed staff, deliver the monitoring, supported by a software platform instead of a staffing vendor. The proposed rule wants the billing practice to furnish the service with its own people, and a software tool your staff runs meets that standard where an outsourced monitoring team does not.

Build two other changes into your workflow now, whichever way the final rule lands. First, add a face-to-face initiating visit before RTM begins. Second, limit RTM to established patients. Both are in the proposal, and both are easy to bake into intake so you are not scrambling later. Set up your scheduling and documentation to require the initiating visit as a gate before any remote monitoring starts, and flag which patients qualify as established. Getting these habits in place early costs little and protects your billing regardless of the final timing.

Move your RTM in-house before the rule forces the issue

The rule isn't final, but the staffing risk is clear enough to start planning now. If your monitoring staff work for an outside vendor instead of your practice, your billing could stop qualifying under this proposal. Moving that work in-house protects it.

Physitrack's RTM platform lets your own employed clinicians deliver monitoring, with software handling the tracking and communication. You keep the billing relationship inside your practice, which is what the proposed rule favors.

Look at your current outsourced contract, then compare it to a staff-delivered model. Even before CMS finalizes anything, building monitoring around your own employed clinicians puts you on solid ground.

Perguntas frequentes

Is the rule final? No. CMS has issued a proposed rule for CY2027, and it can still change. Nothing takes effect until the final version is published.

When are comments due? Within 60 days of the July 15, 2026 notice, per the AHCA/NCAL summary. You can submit comments to CMS during that window.

Does this affect RPM too? Yes. The proposal requires a face-to-face initiating visit before both RPM and RTM begin, and the same staffing restriction applies. Both models sit in scope.

What happens to existing patients under the established-patient limit? The proposal would limit RTM to established patients, so your current patients stay eligible. New patients would need an initiating visit before monitoring begins.

What happens if the 17 codes collapse into four G-codes? CMS has asked for comment on bundling the current RPM and RTM codes into four HCPCS G-codes. If adopted, you would bill simpler bundled codes instead of the current set, which changes your billing workflow but not who is allowed to deliver the service.