A Comprehensive Guide to Remote Patient Monitoring (RPM)

Introduction

Have you heard? There’s a service helping revolutionize the way preventive healthcare is delivered in the United States. Clinicians who embrace remote patient monitoring (RPM) and launch RPM programs can position themselves to not only deliver more effective care but also reap significant financial benefits.

Remote patient monitoring, also referred to as remote physiologic monitoring, is the use of digital technologies to monitor and capture medical and other health data from patients and electronically transmit this information to healthcare providers for their assessment and, when necessary, to provide recommendations and instructions. The Center for Connected Health Policy (CCHP) notes that RPM programs “… can also help keep people healthy, allow older and disabled individuals to live at home longer and avoid having to move into skilled nursing facilities. RPM can also serve to reduce the number of hospitalizations, readmissions, and lengths of stay in hospital — all of which help improve quality of life and contain costs.”

Remote patient monitoring was already gaining popularity before the COVID-19 health crisis. This can be attributed, in part, to the 2020 changes to CPT codes that propelled RPM into the spotlight as one of the most lucrative Medicare care management programs as well as providers increasingly embracing technology to support the health and wellness of their patients.

When the pandemic hit, the value of providing remote patient monitoring services to patients who were expected to reduce travel and direct contact with others became even more apparent. The federal government  recognized this as well, which is why it expanded Medicare coverage of RPM services from just those with chronic conditions to those with chronic and/or acute conditions, among other changes that supported the increased use of RPM.

If we can begin to get a handle on the ever-growing costs associated with treating chronic health conditions, our healthcare system can then turn more of its attention to prevention. Industry leaders are fully aware that one of the most effective ways to drive down the cost of healthcare and improve patient wellbeing and engagement is through effective prevention, but it's hard to focus on this when so many Americans are already in the grip of chronic disease. With remote physiologic monitoring, access to care is greatly expanded and changes in health status can be addressed quickly to avoid crisis. This could translate to substantial annual savings thanks to reduced emergency room visits and hospital admissions and readmissions. 

Drawing attention to these benefits — and many others — is one of reasons why we have created this comprehensive guide for any organization thinking about investing in a remote patient monitoring system (i.e., software, such as Prevounce RPM, and connected patient devices). There are many important considerations to understand, and we’ve covered them all for you.

Remote Patient Monitoring vs. Patient Monitoring

While remote patient monitoring is sometimes confused with patient monitoring as the concepts do overlap in some regards, their difference is important. The National Cybersecurity Center of Excellence (NCCoE), part of the National Institute of Standards and Technology, does a nice job of simplifying RPM vs. patient monitoring when it states the following: “Traditionally, patient monitoring systems have been deployed in healthcare facilities, in controlled environments. Remote patient monitoring (RPM), however, is different in that monitoring equipment is deployed in the patient's home. These new capabilities, which can involve third-party platform providers utilizing video conferencing capabilities, and leveraging cloud and internet technologies coupled with RPM devices, are used to treat numerous conditions, such as patients battling chronic illness or requiring post-operative monitoring.”

Note: RPM is also different from remote therapeutic monitoring (RTM), which is a series of five treatment management service codes. They are as follows:

• CPT 98975 — Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment

• CPT 98976 — Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

• CPT 98977 — Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

• CPT 98980 — Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

• CPT 98981 — Remote therapeutic monitoring treatment, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes

Now that we have defined RPM, let's gain a better understanding of the service.

How Does Remote Patient Monitoring Work?

Even after understanding the definition of RPM, you still may experience a bit of confusion about how RPM works. On the surface, it’s relatively straightforward, but a closer examination is necessary.

Let’s look at some common facts about the RPM process: 

1. A provider identifies the condition(s) to manage remotely and launches a remote patient monitoring program to offer an RPM service to patients. Providers can use remote patient monitoring to collect a wide range of patient health data. This includes blood pressure, heart rate, vital signs, weight, and blood sugar levels.

2. A provider determines that a patient is eligible for and would benefit from remote physiologic monitoring of one or more of the types of health data that can be captured via RPM. With the patient's consent, the provider orders or prescribes RPM. Note: For assistance with identifying patients who are eligible for RPM services, download this quick guide.

3. Once the device is set up appropriately, health data is captured by the device and transmitted from patient to provider, usually electronically. 

4. The provider analyzes this data and gives the patient health and wellness guidance and directions based upon the results.

5. The patient is provided with a device to collect the health data. Remote patient monitoring devices must be electronically connected, which is most often accomplished via cellular networking or Bluetooth. The most common RPM devices are blood pressure monitors, weight scales, blood glucose meters, and spirometers. Other device types that are seeing increased RPM use include pulse oximeters and ECG machines.

To deliver remote patient monitoring services, providers will need to complete other steps, including determining coverage (if considering providing RPM to non-Medicare beneficiaries), establishing a patient base, choosing a device(s), setting up a patient intake program, developing policies and procedures, and training staff. Note: By partnering with a good RPM program vendor, providers will not need to complete some of these steps and will receive assistance with others.

For patients, the ease of their receiving remote patient monitoring will primarily depend upon the design and/or complexity of the devices provided to them. Patients may require assistance (in-person or virtual) to use the technology. 

Understanding what RPM is and how it works is only the first step. Providers are increasingly considering the many benefits that it will provide to their organizations.

Chapter 2: Benefits of Remote Patient Monitoring

That remote patient monitoring is experiencing rapid adoption, as we're seeing at Prevounce, comes as no surprise, considering the significant and wide-spread benefits to providers. In short, RPM is an efficient and effective way for practitioners to closely monitor a patient's chronic health conditions without requiring the patient to physically visit an organization. Physicians have sung the praises of RPM and spoke highly of their remote patient monitoring experiences.

If you need convincing of remote patient monitoring's benefits, just consider some of the statistics about RPM’s growing adoption rate that have been shared:

The increased adoption of RPM comes as no surprise, considering the real benefits to the quality of care that can be delivered via remote patient monitoring. Let’s look into some of the research.

A study from the Consumer Technology Association (CTA), titled “Connected Health and Remote Patient Monitoring: Consumer and Industry Use,” provides valuable insight. Among those included in CTA's national survey were more than 2,000 adults, 100 primary care physicians, 60 endocrinologists, and 40 nurses.

The top three benefits of remote patient monitoring cited by patients were:

1. Detailed information on personalized health

2. Faster access to healthcare services

3. Greater influence on their own wellbeing through ownership of health data.

Healthcare professionals highlighted:

1. Improved patient outcomes

2. Improved compliance rates

3. Patients taking more ownership of their health. 

Meanwhile, MSI International asked American patients to rank the benefits of remote patient monitoring that they valued the most. The results were as follows:

• Convenience – 43%

• Efficiency – 39%

• Control over personal health – 37%

• Greater accuracy – 36%

• Peace of mind – 36%

Certainly, another appealing quality of RPM is that the service is covered by a growing list of insurers and reimburses.

On top of advantages like these, there are several other factors contributing to the upward trend of remote patient monitoring usage. Between public health concerns and challenges associated with delivering care to an aging population, RPM looks like it's here to stay. Practitioners across the country are finding this virtual service to be enticing as a safe and effective means of maintaining the delivery of healthcare to some of their most vulnerable patients.

Also driving the increase in remote patient monitoring usage is that the United States is facing a shortage of practitioners. The Association of American Medical Colleges (AAMC) is projecting a primary care practitioner shortage of as many as 124,000 practitioners by 2034. Compounding the physician shortage is that, according to the U.S. Census Bureau, the U.S. population age 65 and over grew nearly five times faster than the total population over the 100 years from 1920 to 2020, according to the 2020 Census. Since practitioner shortages are inevitable, RPM represents a smart solution to maintaining quality patient care while expanding access to care and reaching more patients who would benefit from remote patient monitoring efficiently and effectively.

The Real Cost of Chronic Health Conditions  

Unfortunately, our reactive way of trying to treat chronic conditions, such as heart disease, diabetes, chronic obstructive pulmonary disease (COPD), and many others, when symptoms arise rather than managing them costs a tremendous amount of money. The United States currently spends roughly $3.7 trillion on treating chronic and mental health conditions, reports the Centers for Disease Control and Prevention (CDC). That's nearly 90% of our total annual healthcare expenditures.  

The cost of healthcare is a painful pill to swallow for everyone. Consider the following about common chronic conditions that can be effectively managed by practitioners and patients by leveraging remote patient monitoring: 

• Heart disease: One-third of all annual deaths in the United States are attributed to heart disease and stroke. That's more than 877,000 Americans. Equally concerning is the fact that these two diseases alone cost our healthcare system around $200 billion annually, and cost U.S. employers about $150 billion annually in lost productivity. 

• Diabetes: The United States currently has more than 37 million people living with diabetes and another 96 million sitting on the proverbial diabetic cliff known as prediabetes. Alarmingly, diabetes is costing Americans more than $325 billion in medical and lost productivity costs.  

• Obesity: Obesity affects more than 40% of U.S. adults. This puts them at elevated risk of chronic diseases like type 2 diabetes, heart disease, and some cancers. Obesity costs the U.S. healthcare system more than $170 billion annually.

• COPD/asthma: The current projected cost of chronic lung issues is around $50 billion annually, with the condition causing U.S. workers to miss millions of days of work per year.

Thanks to the benefits of remote patient monitoring, practitioners and patients are finding that managing these and other chronic conditions is often much easier than they believed was possible. Beyond proactively managing the costs associated with chronic conditions, RPM offers tangible benefits to patients that are hard to deny.

Value of Remote Patient Monitoring for Patients 

Let's review five ways patients benefit from remote patient monitoring:

1. Better access to the healthcare team — Since RPM devices report real-time health data, practitioners are kept in the loop on their patients' current health status, providing patients and caregivers with more peace of mind. 

2. Fewer trips to the practitioner's office — This means less exposure for patients to other illnesses and fewer expenditures in time and money for travel. 

3. Improved quality of care — With RPM, practitioners gain a more holistic understanding of a patient's health condition, which can lead to more accurate adjustments in medications, fewer emergency room visits, and more time between in-office visits.  

4. More control over personal health — RPM typically comes with a user-friendly application for a phone or tablet that provides patients with instant analysis of their wellbeing. This allows for small adjustments to their daily lifestyle that can strengthen management of a condition and help patients better recognize abnormal changes and developments.

5. Better support and education — the healthcare team receives more comprehensive information about a patient's health status, practitioners can provide better individual support and education.

Financial Benefits of Remote Patient Monitoring 

As noted, remote patient monitoring doesn't just deliver clinical benefits. It provides financial benefits to patients and organizations. Updates by the Centers for Medicare & Medicaid Services (CMS) to rules and reimbursement guidelines for remote patient monitoring have allowed the service to expand and grow tremendously. Officially covered by original Medicare, CMS has outlined coverage rules that Medicare Advantage plans must also follow. Most other private insurance companies follow the lead set forth by Medicare.  

For Medicare patients, they should expect copays until they meet their deductible. Once the deductible is met, remote patient monitoring is covered at 80% and beneficiaries can expect to pay on average about $25 per month for each month of monitoring. While this might seem significant, consider the real cost of in-person office visits for close monitoring of chronic health conditions. Between travel time and its associated expenses as well as the wait time in a potentially infectious waiting room, $25 monthly seems like a small price to pay. Another consideration is the cost of hospital admission for unchecked exacerbations of chronic diseases, which in some cases can total in the thousands.  

Meanwhile, for organizations, remote patient monitoring is one of the more lucrative Medicare care management programs. To learn more about RPM reimbursement and billing and coding for RPM, check out this billing guide. 

Benefits of Remote Patient Monitoring for Payers

Health insurance companies, recognizing the growing consumer demand for and cost savings associated with telehealth, are launching “virtual-first” health plans. This insurance makes telemedicine a foundational part of the patient's care, essentially serving as a digital "front door" that allows patients to access virtual healthcare services that guide them to in-person care, when needed. If virtual-health plans are successful and achieve their objectives, the results should be more frequent, improved care access that also lowers costs, among other benefits.

Remote patient monitoring may be the most beneficial of the non-clinical remote services that health plans can consider integrating into virtual-first offerings. RPM allows patients to take vitals measurements in preparation for virtual visits and can be used as part of a care plan to show patients' progress in a more comprehensive way between visits. To learn more about virtual-first health plans and how RPM effectively fits into them, read this column. You can also learn about how the COVID-19 pandemic enhanced the value of RPM for health insurers in this column.

Chapter 4: Examples of Remote Patient Monitoring Applications

When we consider the ease with which remote patient monitoring can be delivered using technology, it’s easy to see how RPM has the potential to transform the delivery of care in the United States. 

To further examine the potential impact of RPM on patient care, we’ve identified nine of the top patient applications for remote patient monitoring, broken down by three of the specialties most frequently offering and prescribing RPM to their patients: cardiology, pulmonology, and endocrinology. 

Cardiology Remote Patient Monitoring 

Within cardiology, there are four noteworthy examples of remote patient monitoring. 

1. Hypertension management — Patients with hypertension are usually relatively or completely asymptomatic, so the only way to accurately identify whether many patients are experiencing high blood pressure is to measure the blood pressure using a monitor. All patients typically need to do is place a cuff on their arm and start the accompanying monitoring device that measures and transmits blood pressure data. 

   Thanks to this simple activity performed on an ongoing basis, cardiologists receive the information they need to advise patients about worthwhile changes in their life in areas including medications, diet, exercise, smoking, drinking alcohol, and consuming caffeine. 

   It's also worth noting that the use of RPM can greatly assist with a specific type of hypertension: gestational hypertension. CDC notes that 1 in every 12 to 17 pregnancies among those between the ages of 20 to 44 is complicated by rising blood pressure. High blood pressure during pregnancy can lead to serious complications, including preeclampsia, eclampsia, preterm delivery, and stroke. Through a maternal health remote monitoring program, RPM makes it easier to monitor blood pressure and improve its control. 

2. Medication management and titration — For patients with high blood pressure, treatment is typically ongoing and involves one or more medications. There are many classes of blood pressure medications. Since blood pressure medication regimens usually undergo frequent and occasionally substantial changes, a remote monitoring device is the best option to deliver practitioners the timely and accurate data they need to recommend appropriate and safe adjustments.

3. Weight measurement for congestive heart failure — It has been shown that patients can gain 10 pounds of “extra” fluid weight before showing any symptoms of congestive heart failure (CHF). Besides increased weight, such as feeling unwell or experiencing swelling, fluid retention — which can occur in the lungs, kidneys, abdomen, legs, and feet — is a common symptom of heart failure. But such weight gain and subsequent fluid retention can easily be missed if not regularly monitored. 

   With daily remote weight monitoring performed using a connected/smart scale, cardiologists receive alerts when cardiac decompensation occurs, permitting fast action that will help improve the patient's condition and decrease the need for hospitalization or urgent care. Daily weight monitoring is considered essential for effective CHF management, with the American Heart Association noting that weight gain is often the first indication of worsening heart failure.  

4. Weight measurement for obesity — Health problems linked to being overweight and obesity include high blood pressure and heart disease as well as type 2 diabetes, strokes, and some forms of cancer. “An increase in body fat can directly contribute to heart disease through atrial enlargement, ventricular enlargement, and atherosclerosis,” states Dr. Harold Bays in Cardiology Magazine. 

   The good news is that obesity is treatable and reversible, and doing so can deliver a wide range of health benefits that include decreasing serious health risks, reducing cholesterol levels, and addressing sleep apnea. With ongoing, remote monitoring of a patient's obesity, cardiologists can provide better and more targeted advice for changes that can help stabilize or decrease weight. 

Pulmonology Remote Patient Monitoring 

There are two examples of remote patient monitoring frequently offered by pulmonologists and a third example encompassing multiple conditions. 

1. COPD management — Chronic obstructive pulmonary disease (COPD) may be incurable, but it is manageable and treatable. To do so, pulmonologists work with patients to develop a plan that combines medications, oxygen therapy, rehabilitation, and support. With remote patient monitoring, pulmonologists gain the ability to perform effectively and timely oversight of COPD. This leads to improvements in decision support and patient adherence to guidance and recommendations. A remote electronic respiratory monitor also allows pulmonologists to virtually support patients while avoiding potential exposure for anyone in their organization to COVID-19, particularly when patients undergo testing and measuring of their lung function. 

2. Asthma management — For asthma patients, pulmonologists can develop an effective management plan that combines exercise, ways to avoid triggers, medications, and other strategies, including remote patient monitoring. The usage of an electronic respiratory monitor is increasingly serving to support asthma patients and help optimize asthma management. And with good reason: Studies indicate that ongoing monitoring of interventions have been directly linked to better asthma control, more symptom-free days, and decreased need for rescue medication. 

3. Other respiratory disease management — While pulmonologists are largely leveraging remote patient monitoring to support COPD and asthma patients, they are also beginning to see an uptick in remote support for patients with cystic fibrosis (CF), bronchiectasis, and other respiratory diseases. It is apparent that as pulmonologists and their patients further embrace RPM, the number of patients with varying diseases who benefit from these virtual services will steadily increase. 

Endocrinology Remote Patient Monitoring 

Within endocrinology, let's examine two common examples of remote patient monitoring. 

1. Glucose monitoring — Like other diseases that can be aided through remote physiologic monitoring, diabetes is chronic and incurable, but there are several ways to reduce the impact of diabetes on a patient's life, including weight loss, diet changes, and engaging in an active lifestyle. Pivotal to managing diabetes and preventing complications is blood sugar testing. Such testing serves to identify when blood sugar levels are high or low and helps with diabetes medication management, evaluation of the effects from changes to diet and exercise, and tracking progress toward treatment goals. 

   For some diabetes patients, blood sugar testing is recommended periodically up to a few times a day. Such patients are increasingly receiving remote support for their diabetes management via the usage of a blood glucose meter. When patients test their blood sugar using this glucose monitoring device, endocrinologists receive the data captured and can make changes to a medication regimen and provide recommendations to improve management, if the information warrants it. Evidence shows that RPM is effective in controlling HbA1c levels in people with type 2 diabetes. 

   Note: RPM is also an effective way to mitigate the effects of gestational diabetes on a pregnant individual and child in utero. CDC reports that 6% to 9% of pregnant individuals in the United States will develop gestational diabetes.

2. Continuous Glucose Monitoring — Ongoing measurement of blood sugar levels is advisable for people with diabetes (mainly those with type 1 diabetes) to detect noteworthy changes in blood sugar levels in near real-time and reveal sugar level highs and lows that fingerstick testing alone may not be able to identify. To perform ongoing measurement, patients are provided a continuous glucose monitoring system, often referred to as a CGM. To use a CGM, a small sensor is attached to the abdomen that includes a cannula which penetrates the skin and performs the “continuous measurement” around the clock (there's a few-minute interval between readings). The data captured is then sent to a device.

   If it's a remote patient monitoring device, the equipment then transmits the information to the prescribing organization for review within the RPM system. As with remote, non-continuous glucose monitoring, remote CGM provides endocrinologists with their patient's blood sugar readings — and most importantly, any that raise red flags (i.e., glucose levels too high or low).

With all these proven applications, it’s evident that implementing a remote physiologic monitoring program can positively impact patient health, but how does RPM impact the financial health of an organization?

Explaining Condition-Focused RPM to Patients

The descriptions above should help you better envision how remote patient monitoring can be incorporated into your organization to benefit your patients. However, if you still have questions about the value of RPM, it may be worthwhile to spend a little more time researching specific applications. As RPM adoption grows, so does the understanding of its numerous benefits.

For example, if you're contemplating whether to add remote patient monitoring to support those patients suffering from congestive heart failure, you may want to read this blog post. It provides an overview of the challenge and effects of heart failure on the U.S. population before explaining how home monitoring for heart failure management can be the difference-maker patients and providers may be looking for. The column then supports this claim with examples of how RPM helps with care delivery for hypertensive patients and weight monitoring as an analogue for monitoring fluid while also explaining the cost-effectiveness of RPM, including for home monitoring of blood pressure.

As another example, if you are considering whether to leverage RPM for patients with lung diseases (e.g., asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis), read this blog post. It discusses the remote measuring and monitoring of peak expiratory flow. Among its key takeaways: 

• Usage of peak flow monitors helps bridge gaps in care caused by reductions in-person visits, whether by choice or necessity.

• There are numerous benefits of remote peak expiratory flow monitoring, both clinical and financial.

• Advancements in technology have made it much easier for organizations to add and provide peak expiratory flow remote monitoring and patients to participate in these RPM programs.

Chapter 5: Financial Considerations of a Remote Patient Monitoring Program

Even if you are convinced of the patient benefits that a remote patient monitoring (RPM) program will deliver, you may still have questions about the financial implications for your organization — and how to best make a program financially worthwhile.

You will need to take a number of essential steps in advance to help ensure the success of the new remote patient monitoring program. These include everything from choosing the RPM system (e.g., Prevounce) that will drive your program to developing an effective mechanism for educating patients on RPM. There is also the not-so-small matter of understanding how you will get paid for your services.

That’s why we have broken down the steps here and provided a quick checklist guide for current remote physiologic monitoring CPT codes. The good news is that, as you will find, building a successful RPM program is fairly straightforward.

Steps to Ensuring Success

Here are four things to know about remote patient monitoring reimbursement.

• Coverage of Remote Patient Monitoring

  Remote patient monitoring is covered by Medicare. As of September 2023, it's also covered in some form by 37 state Medicaid programs, according to the Center for Connected Health Policy.

  Numerous commercial payers also cover remote patient monitoring, sometimes within their telehealth coverage policies.

• Getting Paid for Remote Patient Monitoring

  One of your biggest concerns may be wondering what you can expect to get paid for providing remote patient monitoring services. As previously highlighted, RPM is one of the better reimbursing Medicare care management programs.

Here's how remote patient monitoring reimbursement breaks down using average Medicare reimbursement for 2024:

• Medicare pays about $19 for initial patient enrollment into a remote patient monitoring program. This includes setup of an RPM device and the delivering of any necessary patient education on using the device and receiving RPM services.

• Medicare provides a base monthly payment of about $46 for monitoring patient data transmitted from the device and ongoing management of the device.

• Medicare provides a monthly payment of about $48 for spending 20 minutes communicating with the patient or a caregiver about the transmitted data and any changes to the care management plan.

• Medicare will provide an additional monthly payment of about $38 if such communication with a patient or caregiver exceeds 20 minutes but is less than 40 minutes. If communication requires 40 or more minutes, Medicare will provide an additional — and final — monthly payment of $38. There are no additional payments for communication taking one hour or longer.

When these reimbursement figures are added together, the amount a single remote patient monitoring patient can earn an organization is up to around $170 per month following the initial setup. More often than not, an organization will typically furnish about 20 minutes of RPM care management per month to a patient, which will bring the total monthly reimbursement to around $94 per Medicare beneficiary.

While $94 may not seem like a substantial amount, as a remote patient monitoring program grows, that per patient figure quickly adds up. For example, if your organization enrolls 100 patients into your RPM program and each receives the minimum care management services, that will earn you about $112,800 in annual Medicare RPM reimbursement. Even after covering expenses associated, RPM yields significant and consistent revenue.

Note: By providing RPM in conjunction with chronic care management (CCM) and other services, all as part of a broader comprehensive care management program, organizations will provide their patients with ongoing care that improves health and wellness while also making a more substantial impact on the bottom line. Learn more about the economics of a comprehensive care management program in this column.

• Coding for Remote Patient Monitoring

  The next item to consider is how you will receive those payments. You’ll need to ensure that you code your remote patient monitoring services correctly. Let's briefly examine the CPT codes assigned to RPM.

Most of your remote patient monitoring services will be billed under four codes. These codes are often split into two categories: RPM “service codes” — 99453 and 99454 — and timed RPM “management codes” — 99457 and 99458.

The RPM service codes descriptors are as follows:

• CPT 99453 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment

• CPT 99454 — Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

The RPM management codes descriptors are as follows:

• CPT 99457 — Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes

• CPT 99458 — Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

The Centers for Medicare & Medicaid Services (CMS) stated that CPT 99457 and CPT 99458 can be furnished by clinical staff under the general supervision of the billing provider. If you’d like more detailed information about remote patient monitoring requirements for billing and coding, download this RPM billing guide.

CMS Guidelines for Remote Patient Monitoring

Perhaps one of the most essential steps in preparing to implement a remote patient monitoring program is to reduce the likelihood of claims denials and avoid scrutiny of your billing practices. To do so, you must understand the CMS guidelines for RPM. To qualify for reimbursement, CMS expects providers to ensure they follow these remote patient monitoring requirements:

• Charge Medicare Part B patients a 20% percent copayment. 

• Patients must consent — in writing or verbally — to receiving RPM services.

• The RPM service must be ordered by a physician or other “qualified healthcare professional,” such as a nurse practitioner, certified nurse specialist, or physician assistant.

• Patients must be monitored for at least 16 days to be applied to a billing period (a requirement to bill for CPT 99454).

• Data can be wirelessly synced for evaluation.

In addition, CMS stipulates that RPM devices must meet the U.S. Food and Drug Administration's definition of a medical device.

Remote Patient Monitoring CPT Codes: 4 Tips

Here are four tips to help ensure you use the four primary remote patient monitoring codes properly:

1. A provider can only bill CPT 99454 once per patient every 30 days regardless of the number of devices used.

2. Under CPT 99457, RPM can be performed by the billing physician, qualified healthcare professional, or clinical staff. It requires at least 20 minutes of logged management time each month.

3. Once CPT 99457 has been billed, an organization can add up to two instances of CPT 99458 per month: once at 40 minutes and once at 60 minutes.

4. A provider can bill via these RPM codes during the same service period as chronic care management (CCM) (via CPT codes 99487-99490), transitional care management (TCM) (via CPT codes 99495-99496), and behavioral health integration (BHI) (via CPT codes 99484, 99492-99494).

What to Know About CPT 99091

This remote patient monitoring CPT code requires an additional caveat. Up until the 2021 final rule, organizations could still code with the provider-specific CPT 99091 but rarely did so since the newer RPM codes discussed above were almost always the better option. The 2021 rule declared that 99091 could be billed in addition to the newer care management codes, such as CPT 99457.

However, the new interpretation issued by CMS in that final rule essentially permits providers to bill for an extra "complex" RPM management service when the provider must spend significant time managing a patient and their RPM care plan. Since the 2021 rule change, CPT 99091 can be billed each 30 days whenever complex management occurs without affecting the ability to bill clinical staff time via CPT 99457 each calendar month.

Remote Patient Monitoring Coverage for FQCHs and RHCs

One of the most significant developments of the 2024 Medicare Physician Fee Schedule final rule was CMS's decision to reimburse remote patient monitoring and remote therapeutic monitoring when furnished by federally qualified health centers (FQHCs) and rural health clinics (RHCs). Historically, RPM and RTM codes had not been separately billable by FQHCs and RHCs, with RPM and RTM considered “included” within an all-inclusive rate. That's changed with the final rule, as CMS including RPM and RTM in the general care management HCPCS G0511 starting in 2024.

If appropriate, FQHCs and RHCs can now bill G0511 for:

• Remote physiological/patient monitoring

• Remote therapeutic monitoring

• Chronic care management

• Principal care management

• Behavioral health integration

• Chronic pain management

• Community health integration

• Principal illness navigation

Federally qualified health centers and rural health clinics may bill G0511, which has a base Medicare reimbursement of about $73 for 2024, multiple times in a calendar month for the same patient, provided that minimum requirements are met. This represents an exciting opportunity for FQHCs and RHCs to provide more comprehensive remote care management services to patients while generating meaningful, growable revenue.

To learn more about this significant development for FQHCs and RHCs, as well as the other big changes and additions finalized in the 2024 Medicare PFS final rule, watch this webinar.

Remote Patient Monitoring Audits: Importance of Compliance

Understanding and following proper RPM coding and billing rules is essential to not only getting paid what you deserve but also to ensuring you maintain compliance with rules and regulations. With CMS auditing Medicare Part B telehealth services, RPM compliance is even more essential.

How can providers of RPM services find themselves in auditing hot water? There are those organizations that choose to intentionally violate rules to try to make more money. These scenarios tend to be rare. Rather, most RPM compliance problems stem from either misunderstanding requirements, such as those described above, or engaging with RPM vendor partners that cut corners, either unintentionally or intentionally. You can learn more about the decision by CMS to begin auditing RPM in 2012 and areas likely to be focused on by auditors here.

Now that your coding and reimbursement questions have hopefully been answered, it’s necessary to examine the final consideration: How do you choose a software system that will fit your organization?

Chapter 7: Executing a Successful Remote Patient Monitoring Program

The importance of patient buy-in to executing an effective remote patient monitoring program cannot be overstated. To achieve such engagement is dependent upon your ability to educate patients on the nuances of RPM. To best ensure the short- and long-term viability of an RPM program, you will need patients to initially agree to your recommendation that they begin to use a remote patient home monitoring device and then continue to use the device over time.

Such success will largely depend upon your ability to effectively educate patients on remote patient home monitoring and your RPM program. Consider following these six recommended practices.

1. Define Remote Patient Home Monitoring

   This may seem obvious, but securing patient buy-in begins with ensuring your patients grasp the concept of RPM. Most patients are probably fuzzy on the details of RPM. Others may not be familiar with it at all. Then there are those who may confuse it with other telehealth disciplines or the patient monitoring systems used in controlled healthcare environments to track the likes of body temperature, respiration, arrhythmia detection, oxygen saturation, and end-tidal carbon dioxide. For help with defining remote patient home monitoring and contrasting it with telehealth and patient monitoring, check out this blog post.

2. Describe How Remote Patient Home Monitoring Works

   With the concept defined, you will be in a better position to provide patients with a general understanding of how remote patient home monitoring works. While the details will vary based upon the data your organization is collecting and device(s) used (more on this below), we think this summary from the Center for Connected Health Policy effectively explains the remote patient monitoring home process: “Remote patient monitoring (RPM) uses digital technologies to collect medical data and other personal health information from members in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, blood pressure, heart rate, weight, blood sugar, blood oxygen levels and electrocardiogram readings.

3. Explain the Value of Remote Patient Home Monitoring

   Some patients will look for you to explain why they should proceed with this relatively novel form of care delivery. In other words, what is the value and benefits to patients of remote patient home monitoring?
   
   The answer to this will vary based upon the condition(s) you want to manage, but the patient benefits of using RPM generally include the following:

   1. Keeping people healthy — This includes allowing people to reduce the need to leave their homes and travel to an organization to receive the services provided via remote patient home monitoring, which is particularly beneficial during the pandemic when social distancing is critical to maintaining safety.
   2. Increased collaboration between patient and provider
   3. Allowing the patient to be a more active participant in their care
   4. Reducing the number of hospitalizations, readmissions, and hospital lengths of stay
   5. Reducing patient overall costs — This includes not only healthcare costs but also costs associated with traveling to an organization to receive services.
   6. Permitting older and disabled individuals to remain at home longer and delay or avoid moving into skilled nursing facilities
   
   

   Some patients will get on board when they hear that they will not need to leave their home as much to receive care. Others may only need to hear that remote patient home monitoring will reduce their expenses. You may even have some patients who sign up just because they are excited to try new technology.

4. Provide Instructions on Remote Patient Home Monitoring Device Setup and Usage

   When onboarding new patients onto your RPM program, ensure that they clearly understand what is required to set up and use their device and where they should go for any technical assistance. Do not assume that instructions included with a device will be sufficient for all users. If there is any ambiguity or difficulty in setup and usage, patients may quickly grow frustrated and not remain fully engaged in or ultimately opt out of your program.

   What your organization will need to do to guide patients on how to set up and use their remote patient home monitoring devices will be determined by several factors. Perhaps the most significant is whether the devices use cellular or Bluetooth technology. A cellular device — with an embedded cellular modem — is typically simple to set up and use, only requiring patients to insert batteries and turn the device on. A Bluetooth device, on the other hand, requires the completion of more steps, which may include downloading and installing a smartphone app, connecting the device to the smartphone, and ensuring the smartphone can access Wi-Fi.

   How much work you will need to do to help patients complete these processes and troubleshoot issues that arise will depend upon the company you partner with to serve as your remote patient home monitoring vendor and the type of program you enter into with this partner. Some RPM device vendors will provide your organization with device setup instructions and then expect you to take the lead on helping patients going forward. Other vendors will be more active in supporting setup and answering questions that come up during setup and ongoing usage. Full-service programs (often associated with cellular devices) typically include a more active vendor that provides technical support while self-managed programs (often associated with Bluetooth devices) typically require organizations to handle the bulk of the work.

5. Deliver Remote Patient Home Monitoring Education Via Multiple Channels

   It’s best to employ a variety of communication methods to cater to differing patient needs. For example, some patients may prefer an initial discussion about remote patient home monitoring in person, over the phone, or via videoconference. Others may want to receive information by direct mail, email, or through links to resources delivered via text message. Providing information on your organization's website about your program and specific devices, including setup and troubleshooting, can serve as a valuable reference for patients who are comfortable accessing information in this manner. For setup of more complex (i.e., Bluetooth) devices, consider posting or linking to videos from your website.

   When performing initial outreach to patients about your remote patient home monitoring program, ask if they prefer how to receive education. This will help them feel like they are in greater control of their experience and may alleviate some concerns about using a new technology. By making it as easy as possible for patients to join and remain active participants in your remote patient home monitoring program, you should be able to achieve and maintain success in delivering virtual care while streamlining operations, thus keeping costs and resource usage lower.

6. Strengthen Remote Patient Home Monitoring Education

   Efforts to improve patient communication can include something as simple as revising language used to reduce possible confusion to more significant undertakings, such as developing new teaching resources and leveraging new communication channels. Regularly request feedback from patients about their experience with your remote patient home monitoring program, including where they thought education was strong and weak and any ideas they have for improvement. If patients stop using the device and opt out of the program, work to determine the reason(s) and explore whether you can make changes to how you provide education that could help avoid a similar fate for other patients.
   
   You should also ask staff who support your remote patient home monitoring program and are involved with patient education if they have recommendations for improvement or new ideas to enhance your education efforts. Even small enhancements may reap significant short- and long-term rewards for your RPM program.

Conclusion

Suffice it to say, remote patient monitoring is not only here, but here to stay. Remote patient monitoring had been quietly evolving for decades. Thanks, in part, to the global pandemic, it has become an integral part of our healthcare delivery system. Medicare and private health insurers are taking note of the cost-effectiveness and positive health outcomes associated with RPM, which is contributing to better access to the service for those patients who benefit most from RPM. In addition, as federal and commercial payers are supporting RPM services, patients are increasingly looking for them. Now it's up to organizations to meet the demand.

Moving forward, patient and practitioner understanding of remote patient monitoring will continue to rise and technology will become more sophisticated, yet often easier to use, which should spur even further adoption. This represents a tremendous growth opportunity for organizations, especially if they can work with a solid technology partner who will help — and not hinder — their upward trajectory.

The future of virtual health services like remote patient monitoring is brighter than ever, and following best practices and guidelines is key. So is choosing the right software partner. Prevounce functions as a partner that can guide you through the RPM process and help you identify the equipment and software to provide care that best meets your patients’ and organization's needs.

Prevounce supports its clients from start to finish. For example, we can help you determine a patient’s eligibility as well as create superbills for your staff at the end of each month. This end-to-end approach helps makes transitioning to an RPM program seamless and without creating additional workflows or workarounds for your organization. We also place the highest priority on security and compliance. Patient data is secured end-to-end, and our technology supports you getting paid what you deserve while keeping you on the right side of regulations.

With a better understanding of remote patient monitoring, including why it is quickly becoming a sought-after service by patients and one that healthcare organizations should strongly consider adding, you can take the next step in building a successful RPM program with confidence. As the developer of a remote patient monitoring platform that helps organizations easily expand patient care outside their walls, we at Prevounce are excited to see how RPM expands and evolves into the future. If you’d like to learn more about our platform, book a meeting with us here.

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Disclaimer

Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.

Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.

The coding options listed here are commonly used codes and are not intended to be an all- inclusive list. We recommend consulting your relevant manuals for appropriate coding options.

The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.