A nursing facility's Medicare Part A consolidated billing rule can require the facility itself, not the physician who ordered remote patient monitoring or the vendor running it, to be the one that bills Medicare. Between 2019 and 2022, Medicare enrollees receiving remote patient monitoring (RPM) grew more than tenfold, from 55,000 to 570,000, and the HHS Office of Inspector General has since flagged the resulting claims for fraud risk. A nursing facility resident's RPM claim can run through three possible billers: the physician, the facility, and the vendor that supplies the device and staffs the monitoring. Getting the biller wrong exposes the claim to recoupment and, at times, to False Claims Act liability.
The Billing Practitioner Requirement
CMS's December 2025 Telehealth and Remote Monitoring booklet states that only physicians and non-physician practitioners eligible to bill evaluation and management services may bill remote monitoring, so CPT codes 99453, 99454, 99457 and 99458 carry a single named billing practitioner, not a facility's provider number or a vendor's tax ID. Only one practitioner may bill a patient's remote monitoring in any 30-day period, and the requirement to collect at least 16 days of data for the setup and device-supply codes does not apply to 99457 and 99458. Auxiliary personnel, who under 42 CFR 410.26 may be employees or independent contractors of the billing practitioner, may furnish that treatment-management work under the practitioner's general supervision, meaning the practitioner need not be on-site. That standard is what makes a vendor-staffed RPM program possible: the vendor's technicians act as auxiliary personnel, while the practitioner, not the vendor, orders, reviews, and bills the service.
Why the Nursing Facility Setting Changes the Answer
A Medicare Part A covered stay adds a rule that does not exist for an RPM patient at home. Under the Medicare Claims Processing Manual, a physician's professional services are excluded from a facility's consolidated billing and billed directly to Part B. The same section carves that exclusion back for services performed by someone else as incident to the practitioner's service: those remain subject to consolidated billing and must be billed by the skilled nursing facility itself. RPM's usual structure, where auxiliary personnel handle the monitoring and interactive communication making up 99457 and 99458, is an incident-to arrangement. For a resident in a covered Part A stay, the facility, not the physician's practice or its vendor, has the stronger claim to bill those codes. Outside a Part A covered stay, including long-term custodial residents and residents whose Part A benefit is exhausted, consolidated billing does not apply, and the practitioner bills Part B as usual.
The nursing facility's consolidated billing status, not the vendor's contract, decides who may lawfully bill a resident's remote monitoring claim.
The Vendor's Limits and the Audit Risk
A monitoring company can supply the device, host the data platform, and staff the daily review as the billing practitioner's auxiliary personnel, but it cannot bill Medicare in its own name; the rule ties the claim to a practitioner, not a corporation. The HHS Office of Inspector General's September 2024 report on remote patient monitoring found enrollment grew more than tenfold between 2019 and 2022, that 43 percent of enrollees did not get all three billed components, and that Medicare's claims data does not reliably show who ordered the monitoring. A November 2023 OIG consumer alert separately warned that some companies sign enrollees up for RPM regardless of medical necessity and bill monthly even when the monitoring never happens. Any UPIC, Medicare Administrative Contractor, or OIG review of an RPM claim starts with who ordered it and whether the file shows it. A nursing-facility arrangement where a vendor's free devices, per-resident fees, or revenue share decide which residents get enrolled, rather than a documented physician order, can separately raise anti-kickback statute exposure.
Health Law Alliance's attorneys have overseen 2,000+ audits and handled 5,000+ matters, with 25+ years of experience.
Why Early Legal Counsel Is Critical
It is critical that nursing facilities, physician practices, and remote monitoring vendors promptly retain experienced healthcare defense counsel upon receiving an audit notice, a prepayment review request, or any other government or MAC inquiry tied to remote patient monitoring billing. Early legal intervention can protect the provider's rights, ensure appropriate responses to government and contractor requests, avoid inadvertent admissions, preserve relevant defenses, and allow counsel to communicate with investigators or contractors on the provider's behalf. Delaying legal representation can significantly affect the outcome of a matter and expose the provider to unnecessary risk.
How Health Law Alliance Can Help
Health Law Alliance represents physicians, nursing facilities, and remote monitoring vendors in Medicare billing disputes and program integrity reviews tied to remote patient monitoring. Our attorneys sort out which party was the correct biller under a resident's Part A status before an auditor reaches the same question. If your facility or monitoring program is facing an RPM audit or recoupment demand, contact our remote patient monitoring audit defense attorneys for a free, confidential consultation.
