Remote Patient Monitoring (RPM)
How Does Remote Patient Monitoring Work?
Medicare’s Remote Patient Monitoring (RPM) program reimburses providers for:
- Using digital devices to collect and transmit patient clinical data
- Clinician’s time to review the data to make changes to the patient’s care plan
- Intervening if clinical data indicates an exacerbation that could be detrimental to the patient
The Centers for Medicare & Medicaid Services (CMS) developed this program to help providers monitor patients’ chronic and acute conditions in real time, improve patient engagement, and develop comprehensive care plans that enhance health outcomes.
Medicare RPM program basics
RPM enables daily monitoring of patient health data, including vitals, via Internet- or Bluetooth-enabled remote devices, such as blood pressure monitors, glucometers, pulse oximeters, and weight scales.
Providers can successfully submit RPM claims by meeting core requirements, including:
- Acquiring and documenting patient verbal or written consent
- Overseeing patient data in a HIPAA-compliant software solution
- Connecting with each patient for a minimum of 20 minutes per month
- Receiving 16 daily readings within a calendar month
It is also recommended to:
- Document notes, goals, and next steps with an EHR solution
- Manage clinical staff to ensure adequate patient focus
In addition to ongoing data analysis, RPM supports care management services, such as:
- Individual care planning
- Engagement with the care team
- Prescription refills
- Referrals to specialists
- Physician reviews
And, while providers with an NPI number must oversee and ultimately bill for the service, licensed healthcare professionals can assist with RPM management, including:
- Physicians
- Physician assistants
- Nurse practitioners
- Certified nurse midwives
- Clinical nurse specialists
- Pharmacists
- Registered Nurses
The core requirements for RPM include eligibility, device readings, and monthly access time.
- Eligibility requirements: Patients must have at least one chronic or acute condition that warrants RPM services. Additionally, only established patients who have been evaluated and have a treatment plan can participate.
- Minimum device readings: Providers must capture a minimum of 16 daily readings each month.
- Minimum time spent: The care team must spend at least 20 minutes each month delivering RPM services, including reviewing and analyzing patient data and taking actions related to data insights.
RPM complements other Medicare care management programs
CMS encourages providers to combine RPM with other Medicare programs, such as Chronic Care Management, Behavioral Health Integration, and Transitional Care Management. Concurrent billing of RPM with these other programs is approved as long as the individual program requirements are met.
Utilizing remote patient data complements these programs by providing analysis and notifications that alert care teams to concerning clinical trends and care gaps that require intervention or follow-up.RPM provides real-time data, helping care teams detect trends, confirm if care plans are working, and address gaps in care promptly.
For example,Combining CCM and RPM allows real-time monitoring of chronic conditions, improving clinical outcomes and generating financial benefits for the practice.
How does RPM work? Four RPM program activities
Remote Patient Monitoring entails four main steps.
These ensure a program meets auditing requirements, educates patients on remote device use, and provides ongoing engagement and intervention.
When supported by robust HIPAA-compliant software, an RPM program can be a profitable way to maximize staff time and have a real-time view of a patient’s health and status, enabling timely decision-making.
Activity One: Identify and enroll RPM patients
Determine which patients would benefit most from at-home monitoring via remote devices. RPM use is most common for patients with diabetes, hypertension, heart disease, chronic kidney disease, and Chronic Obstructive Pulmonary Disease (COPD).
Patients who qualify for the Medicare RPM program must have a chronic or acute condition that is:
- Expected to last at least 12 months or until end-of-life
- Pose a risk of death, acute decompensation, or functional decline
- Be noted by the provider 12 months before enrollment
Remote Patient Monitoring can be used to help support care for a number of health conditions. It’s often used to track symptoms and conditions associated with:
- Heart disease and high blood pressure
- Diabetes
- Pulmonary conditions
RPM can also be used to manage and track a number of other health conditions and services, including:
- Perinatal care
- Post-surgical recovery
- Obesity and malnutrition
- Vertigo or syncope
- Cancer
- Neurological disorders
Enrollment is typically completed during an evaluation or Annual Wellness Visit with written or oral consent documented. During enrollment:
- Explain how RPM can benefit the patient.
- Discuss any associated costs (Medicare Part B copay).
- Ensure patients know they can opt out at any time.
Activity Two: Onboard patients and set up RPM devices
Remote Patient Monitoring devices capture patient data from home and transmit it directly to providers.
Devices must meet criteria for a designated medical device, as determined by the Food and Drug Administration. These include a host of cellular - and Bluetooth-enabled devices, including:
- Blood pressure monitors
- Glucometers
- Heart rate monitors
- Pulse oximeters
- Spirometers
- Thermometers
- Weight scales
During onboarding, ensure patients understand how to use the devices and how frequently readings should be taken. This ensures accurate data collection and fulfills CMS’s requirement for 16 monthly readings. They also need to know the frequency at which they should use the device.
Clinicians should receive adequate information for trend analysis and to meet CMS’s minimum requirement of 16 readings each month.
CMS reimburses for this device setup, which can be billed once per device and only once per month.
Activity Three: Ongoing patient data monitoring and intervention
The heart of any RPM program is receiving patient data, analyzing and gaining insights from that data, and taking action, if necessary. Seamless data receipt, visualization, notifications, and reports are vital to providing ongoing patient monitoring without manual management.
RPM devices collect a host of physiologic data, including:
- Vital signs like blood pressure, heart and respiration rates, temperature, and oxygen saturation
- Weight, activity, and sleeping patterns
- Subjective data like mood symptoms, fatigue or pain levels
Clinicians review collected data to see if there are any positive or concerning changes or trends that indicate the patient’s care plan needs adjusting. Alternatively, they can receive automated alerts when patient data is outside desired boundaries and timely intervention is needed to avoid exacerbation, disease progression, or hospitalization.
The insights gleaned from RPM device data help clinicians adjust medication doses or regimens, know if a patient’s medical condition is improving or worsening, and provider oversight of their health status between in-office appointments.
Activity Four: Billing for RPM services
Billing and claims administration entails capturing required information, documenting care team activities accurately and appropriately, and guaranteeing monthly bills meet compliance rules.
This safeguards that providers are paid on time and mitigates the risk of denied claims.
Monthly RPM billing requirements
CMS has established four CPT codes to reimburse for RPM devices and services:
- CPT code 99453 covers device setup: This can be claimed only once per device and cannot be billed more than once in a 30 day period per patient. For example, if a patient receives two devices within the same calendar month, only one device can be billed for that timeframe. The second device would be billable in the subsequent month.
- CPT code 99454 covers device use: This can be claimed once per month per patient, no matter the number of devices employed by that patient. It should be billed in 30-day increments only if the patient takes at least 16 daily device readings that same month. These readings do not need to be taken on consecutive days.
- CPT code 99457 covers clinician time: A clinician or certified resource must provide at least 20 minutes of service in reviewing patient data and analysis, as well as decision-making and care coordination based on data trends.
- CPT code 99458 covers additional time: An unlimited number of 20-minute increments are available if additional time is needed for data review, care plan changes, care coordination, or supporting patients remotely.
ThoroughCare maximizes the value of Remote Patient Monitoring
ThoroughCare is a comprehensive software platform that supports end-to-end RPM workflow. Our platform offers a structured approach to Medicare care management programs while enabling flexibility to meet individual patient needs. This includes:
- Facilitate patient consent and enrollment
- Ordering, registering, and managing RPM devices
- Integrate with RPM devices to capture data
- Alert care teams when RPM data is outside set patient parameters
- Create and maintain goal-driven care plans
- Automating device- and time-based claims documentation for auditing
- Simplify claim submission and documentation compliance
Key questions answered
What is Remote Patient Monitoring?
Remote Patient Monitoring (RPM) is a Medicare value-based care program. It allows providers to bill for using digital devices to capture and transmit clinical data from patients in their home or community settings. The program focuses on providing real-time measures as part of ongoing monitoring of a patient’s medical condition. Datacan be analyzed and used to change the patient’s care plan or intervene if readings fall outside of desired boundaries.
What are the main parts of a Remote Patient Monitoring program?
An RPM program has four main activity areas:
- Enrolling eligible patients
- Onboarding and device setup
- Ongoing monitoring and intervention
- Billing for monthly services
Each area is driven by meeting CMS requirements for service delivery, including device- and time-based billing across four CPT codes.