Send your monthly export. We check every record against Medicare's rules and return one decision per record — with the rule, the source and the evidence behind it.
- We never submit claims
- De-identified records for the sample
- BAA before any PHI
March 2026 export
Northbay Billing · 14 practices · 1,284 records
RULE SET 2026 FINAL
Ready 912 · Repair 231 · Hold 89 · Expert review 52
| RECORD | CODE | CHECK | DECISION |
|---|---|---|---|
| 4471-B | 99454 | Ready | |
| 3092-A | 99457 | Repair | |
| 5518-C | 98977 | Hold | |
| 2207-D | 99458 | Expert review | |
| 6630-A | 99454 | Ready |
Every decision links to its rule and evidence
Open packet →The product
Every claim and every reason, on one screen.
Ready, repair, hold and expert review for the whole export, with dollars at risk by root cause.
Why now
RPM grew fast. So did the scrutiny.
Medicare RPM payments in 2024, up from $15M in 2019.
SOURCE · CMS
of RPM patients did not get every required part of the service.
SOURCE · HHS-OIG
False Claims Act settlement, June 2025 — devices that did not send readings automatically.
SOURCE · DOJ
How it works
Your export in. A decision per record out.
No integration, no new software for your billers. CSV and PDF upload to start.
01
Send the month
Upload what you already export. We map the columns once per client and keep the mapping.
02
See every decision
One decision per record. Open any record and read the check, the rule and the evidence row behind it.
03
Fix, sign, export
Fixable gaps queue up by cause. A certified coder signs the hard cases. Ready claims export with a signed packet per patient.
The four decisions
Four answers. Never a guess.
When the evidence is unclear, a record gets hold or expert review — never ready. Every rule carries a source, effective date, payer and tests.
Ready
All evidence present, all checks pass.
NEXT
Biller may submit.
Repair
A specific, non-clinical gap that can be fixed.
NEXT
Operator fixes it, record runs again.
Hold
The record does not support billing.
NEXT
Do not submit until new evidence or an expert decision.
Expert review
Rule interpretation, medical need, or conflicting records.
NEXT
A certified coder decides and records why.
Try the checker
Change the facts. Watch the decision move.
This is the real rule set, 12 RPM checks from the CY2026 Medicare final rule, running in your browser on one synthetic patient. Nothing you change leaves this page.
SYN-000140 · CEDAR CARDIOLOGY · MARCH 2026
Synthetic patient. Blood pressure cuff, hypertension.
Decision
Repair
- Safe to bill
- $51.77
- Held back
- $52.11
- Repair
16 or more days of readings in the 30-day period
RPM-DEV-01 · 90 FR 49397 - Ready
Readings come from a medical device that uploads them automatically
RPM-DEV-03 · 85 FR 84543 - Ready
20 or more minutes of management in the calendar month
RPM-MGMT-01 · 88 FR 78882 - Ready
At least one live, interactive communication with the patient in the month
RPM-MGMT-03 · 90 FR 49397 - Ready
Patient consent on file, at the latest when the first service is furnished
RPM-CONS-01 · 85 FR 84544 · MLN901705 p. 13 - Ready
Established patient before monitoring starts
RPM-EST-01 · 88 FR 78884 - Ready
One practitioner bills device codes per 30-day period; never RPM and RTM together
RPM-OVL-01 · 88 FR 78883 - Ready
Each device code billed once in the 30-day period
RPM-DUP-01 · 88 FR 78883
Amounts are CY2026 national non-facility rates from the CMS fee schedule. The full audit also reads notes, rosters and claim files, and checks overlaps across billers.
Audit packet
The file an auditor would ask for, already built.
Every patient gets a packet: the evidence behind the decision, in the order a reviewer reads it. Expert corrections become tests, so the same mistake is not made twice.
- Consent and starting visit
- Day calendar per 30-day period
- Time ledger per calendar month
- Rule, source and effective date
- Reviewer and reason
PATIENT 4471-B · 99454
Device period 02/14 – 03/15
ReadyDAYS WITH READINGS
18 of 30 · 16 needed
TIME LEDGER · MARCH
24 min · live call 03/09
- 03/04J. Alvarez, MAReviewed readings8 min
- 03/09J. Alvarez, MALive call · med adherence11 min
- 03/21R. Chen, RNThreshold follow-up5 min
CY2026 PFS final rule · 99454 requires 16+ days of data in 30 days · effective 01/01/2026
What is at stake
Put your numbers in.
Each RPM patient on 99454 and 99457 bills $103.88 a month at the CY2026 national rate. A record with a gap is money a payer can take back.
For scale: HHS-OIG found that 43% of RPM patients did not get all 3 parts of the service (OEI-02-23-00260, 2024). National non-facility rates; your MAC's locality rates differ.
Billed per month
$83,104.00
At risk per month
$8,310.40
At risk per year
$99,724.80
How to start
Start with one audit. Keep what earns its place.
Priced per record reviewed — never a percentage of your Medicare payments.
STEP 1
Retrospective audit
$500–2,500fixed fee
50–100 de-identified records from last quarter. See what we find before you commit.
Book a sample auditSTEP 2
Monthly review
Per recordmonthly minimum
Every record, every month. Decisions, repair tasks and an audit packet per patient.
Talk to usSTEP 3
Pre-submission check
Platform minimum+ usage
A daily check inside your billing workflow, before claims leave the building.
Talk to us