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CMS’s Proposed Enrollment Requirement Asks Providers to Stop Practicing Medicine for Hours

By Jon-Michial Carter, Co-Founder and CGO, ChartSpan

In the Calendar Year 2027 Physician Fee Schedule Proposed Rule (CMS-1848-P), CMS proposes that Remote Physiologic Monitoring (RPM) may begin only after the billing practitioner personally initiates the service during a separately billable in-person or telehealth visit. At that visit, the practitioner must discuss the program with the patient, determine that monitoring is appropriate, and obtain the patient's consent.

We share CMS's commitment to program integrity. Every dollar Medicare spends should trace to a service a patient actually received and understood. But this particular provision will not strengthen integrity. It will convert physicians, nurse practitioners, and physician assistants into administrative clerks, and it will do so at the expense of the patients who depend on remote monitoring most.

What a compliant enrollment actually requires

To enroll a patient compliantly, Medicare requires consent at or before the start of RPM services, and that consent must include an acknowledgment that the patient is responsible for the applicable cost sharing, including any coinsurance and deductible.

Consider what it takes to deliver that disclosure truthfully. Before anyone can tell a patient what RPM will cost them, someone has to verify the patient's primary and secondary insurance coverage, confirm their demographics, and determine whether supplemental coverage absorbs the cost sharing or whether the patient will owe it out of pocket, and if so, how much. That is coverage research and benefits verification. It is careful, necessary work, and it is not the practice of medicine.

The proposed rule would place that work squarely on the provider in the exam room. A clinician who is asked to sift through claims data and demographic records to calculate a patient's financial obligation is not evaluating a heart rhythm or adjusting a medication. They are doing the job of a billing office, and in the middle of a visit.

Most providers will say freely that they do not want this work and are not good at it. That is not a criticism. It is the same reason practices do not ask their physicians to submit their own claims or run their own eligibility checks. In my years in care management, I have never observed a provider complete a fully compliant enrollment, with an accurate coinsurance and deductible disclosure, in the course of a clinical visit. It does not happen today, and mandating it will not make it happen. It will simply mean fewer enrollments.

Medicare has already defined the compliant path

CMS's own regulations recognize that auxiliary personnel, including staff contracted through a third party, may furnish care management services and obtain patient consent under the general supervision of the billing practitioner (42 C.F.R. § 410.26; CY 2021 Physician Fee Schedule Final Rule). This is not a loophole. It is a deliberate structure CMS built so that trained specialists handle the administrative rigor of enrollment while the provider retains direction and control over the clinical service.  It makes perfect sense!  

Enrollment specialists working under that framework do exactly what compliance demands. They research the patient's coverage before the conversation, disclose the actual financial obligation, confirm the patient's right to stop at any time, and document all of it. At ChartSpan, we audibly record every single enrollment phone call, retain those recordings for ten years in case of an audit or question, and document the enrollment thoroughly in the patient's record. That is what an informed, auditable consent looks like, and it is a higher standard of documentation than a checkbox note from a rushed office visit will ever produce.

A mandatory visit is a strange remedy for overspending

There is a second irony in the proposal. If the concern is unnecessary Medicare spending, requiring a separately billable evaluation and management visit whose practical purpose is to capture a consent creates new spending. The patient owes cost sharing on that visit. The taxpayer funds the balance. Patients in rural areas may drive an hour each way for it. A policy motivated by fiscal discipline should not begin by generating an office visit that neither the patient nor the provider clinically needs.

The patients who lose are the ones with the least access

If providers will not perform enrollments, and the evidence of two decades of care management says they will not, then enrollment volumes will collapse and the program will quietly wither. The patients harmed first will be those in rural communities who already struggle to reach care, and minority and underinsured populations for whom remote monitoring has demonstrably improved outcomes. In a nine-site health system serving underinsured patients, hypertension control improved from a 46 percent baseline to 55.3 percent with remote monitoring in place (“Remote Patient Monitoring Works: Clinical Evidence from Three Health Systems,” July 2026). Those are the gains at stake.

Where this started, and a better way forward

These proposals trace back to a 2024 HHS Office of Inspector General report on RPM oversight. The report raised questions worth asking, but its findings have been widely read as evidence of pervasive fraud, and the underlying data does not support that conclusion. I have written a detailed analysis of the report's methodology and claims, available at SaveRemotePatientMonitoring.com.

There is a better way to protect the Medicare Trust Fund, and the Save RPM Coalition has proposed it: registration and enforceable accountability standards for the organizations that support remote monitoring, so that CMS can identify bad actors without dismantling compliant programs and the patient access they provide.

What we are asking

If you are a provider organization or a remote monitoring company, we want you with us. Join the coalition and find model comment language, data, and updates at the Save Remote Monitoring landing page. Then file your own comment through Regulations.gov under file code CMS-1848-P before September 14, 2026. The public record is how this rule gets fixed, and every voice on it counts.

This benefit was hard won. Let's not lose it to a well-intentioned mistake. #SaveRemoteMonitoring

Formal participation and submission of public comments

To ensure your voice is documented before the September 14, 2026, deadline at 11:59  p.m. ET, clinicians and stakeholders are encouraged to utilize electronic filing for immediate confirmation:

1. Navigate to the formal regulatory docket at Regulations.gov referencing file code CMS-1848-P for the CY 2027 Physician Fee Schedule.
2. Locate and select the "Comment" option prominently displayed on the docket landing page.
3. Input your testimony directly or upload a comprehensive Word or PDF document. For evidence-based, data-rich submissions, a formal attachment is preferred. Ensure the header of your submission clearly cites CMS-1848-P and identifies the specific provision(s) of the proposed rule you oppose. 
4. Finalize the required fields, indicating your status as an individual or organizational representative, and retain the provided tracking number for your records.

While written correspondence is accepted via mail at the addresses specified in the Federal Register, the coalition recommends electronic submission to guarantee a verifiable record of your advocacy.

Effective advocacy depends on specificity; CMS prioritizes submissions that provide tangible operating costs and sourced labor figures over subjective feedback. We urge practices to attach relevant invoices and economic data to substantiate their position.

Sources

1. CMS, CY 2027 Medicare Physician Fee Schedule Proposed Rule fact sheet (CMS-1848-P). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

2. PYA, Providing and Billing Medicare for Remote Patient Monitoring (consent must acknowledge beneficiary responsibility for the co-payment or deductible). https://www.pyapc.com/wp-content/uploads/2024/01/Providing-and-Billing-Medicare-for-RPM-PYA-010924.pdf

3. CMS, MLN901705, Telehealth and Remote Patient Monitoring (auxiliary personnel may obtain consent under general supervision). https://www.cms.gov/files/document/mln901705-telehealth-remote-monitoring.pdf

4. 42 C.F.R. § 410.26 (general supervision; auxiliary personnel, including contracted staff).

5. HHS OIG, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260). https://oig.hhs.gov/documents/evaluation/10001/OEI-02-23-00260.pdf

6. Save RPM Coalition, SaveRemotePatientMonitoring.com (OIG analysis and coalition proposals). https://www.saveremotepatientmonitoring.com

7. Remote Patient Monitoring Works: Clinical Evidence from Three Health Systems, July 2026. https://info.chartspan.com/rpm_clinical_evidence-review.