Episode Details

Most pharmacies launching remote patient monitoring programs make the same expensive mistake. They assume Medicare billing works like filling prescriptions, submit claims based on services delivered, and then watch thousands of dollars in denials roll in. The problem isn't the quality of care they're providing. It's that RPM reimbursement follows rules that contradict everything pharmacists learned about getting paid for their work. Here's what's really happening. Medicare pays for RPM in two completely separate buckets. One covers collecting patient data from home monitoring devices. The other pays for the clinical time you spend reviewing those numbers and managing care. But here's the catch that trips up most pharmacies: you can't bill Medicare directly at all. Your pharmacy isn't on Medicare's approved list of RPM billing providers, even though you're doing exactly the kind of medication management and chronic disease monitoring these patients desperately need. So how do successful pharmacies actually get paid? They partner with physicians through something called incident-to billing arrangements. Under general supervision from a doctor, your pharmacy delivers the RPM services while the physician bills Medicare and compensates you through a contractual agreement. Think of it as working behind the scenes while the doctor's practice handles the front-end billing. The physician maintains overall responsibility for the care plan and stays available when you identify issues requiring their clinical decision, but they're not hovering over every patient interaction you have. Now, the current system has some rigid requirements that don't always match real-world patient needs. Patients must transmit device readings for at least 16 days within 30 days before you can bill for the monitoring. Care management time bills in 20-minute chunks, and Medicare allows up to 80 minutes per patient monthly. If a patient only needs 15 minutes of your clinical attention, you get paid nothing because it falls short of that 20-minute threshold. But 2026 brings changes that could make RPM much more practical for certain patients. Proposed rules would allow billing when patients transmit data just 2 to 15 days per month for respiratory, musculoskeletal, and behavioral health monitoring. This matters because these conditions often involve intermittent symptoms that don't require daily tracking, yet continuous monitoring still provides real clinical value. The proposals also introduce a payment tier for 10 to 19 minutes of monthly care time, finally compensating pharmacies for patients who need regular oversight without intensive intervention. The documentation requirements deserve your serious attention because enforcement authorities have flagged RPM as a fraud concern area. You need systems to track every billable activity with precision. When did you provide the device? What time did your staff review the transmitted data? How many minutes did you spend on each review? What actions did you take based on the findings? When pharmacies can't produce clear records showing exactly what services happened and when, Medicare denies payment and can even recover amounts already paid. Common mistakes happen when pharmacies bill for services before patients hit that 16-day transmission threshold, or when they count administrative tasks toward clinical time. Scheduling appointments and processing paperwork don't qualify as billable care management time. Only actual clinical activities like reviewing vital signs, adjusting care plans, or communicating with patients about their conditions count toward that 20-minute mark. The best provider partnerships start with physicians who already refer patients to your pharmacy and appreciate the clinical value you bring to medication management. These doctors understand how your team can extend their care reach while solving operational challenges in managing their own RPM programs. You handle equipment logistics, patien