Operational guidance and analysis for APCM, RPM, RTM, and value-based care execution.
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
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If you run an independent practice, rapid RPM growth probably still feels like a win.
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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. This code, which reimburses for the supply of the device and data transmission, has long carried a notorious "all-or-no…
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Beginning January 1, 2026, UnitedHealthcare (UHC) will dramatically narrow coverage for Remote Physiologic Monitoring (RPM) across its commercial, Medicare Advantage, and exchange plans.
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If you are billing RPM for Diabetes, Hypertension, or COPD under UHC, your claims will likely be denied starting January 1st.
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Originally published at: https://fairpath.ai/resources/cms-rpm-apcm-2025-26
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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…
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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…
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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…
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The CMS 2026 Physician Fee Schedule updates reshape how remote care coordination can be staffed, supervised, and reimbursed. Here’s what changed and how to operationalize it.
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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…
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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.
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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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This blog outlines a groundbreaking proof of concept for reimagining medical ontologies and artificial intelligence. Buffaly demonstrates how large language models (LLMs) can unexpectedly enable symbolic methods to reach unprecedented levels of effectiveness. This fusion deliver…
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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…
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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…
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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…
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