Remote Patient Monitoring (RPM) is a point of opportunity, right?
For patients, this Medicare benefit is an opportunity to collect and regularly monitor their health vitals from the comfort of home. For medical providers, the program establishes a new stream of revenue, as well as helps improve patient care. Others have even found entrepreneurial pursuit in it.
Many have built third-party businesses to capitalize on healthcare organizations that outsource remote monitoring administration. But, as someone who may have an interest in starting their own RPM consulting business, are you fully aware of the rules and regulations, or the resources required?
Starting such a business may initially appear straightforward. But the ins and outs of this Medicare benefit, as well as the time intensity of providing it, can catch anyone off guard. You could walk into a mess without preparation or knowledge.
At ThoroughCare, we’ve worked with more than 600 clinics and physician practices as they’ve established and scaled care management and telehealth programs, such as RPM. To be clear, though: ThoroughCare does not provide consultation to third-party benefit management companies. We simply provide a software solution to help manage RPM.
But our experience with patient care programs has drilled a broad array of knowledge and perspective into our collective company head. In this article, we’d like to share this expertise to help you determine whether starting an RPM consulting and management business is right for you.
We’ll cover the rules and regulations of remote monitoring, as well as best practices when starting an RPM business.
Rules and Regulations for Remote Patient Monitoring
Medicare established RPM as a general telehealth option for its insured population.
Through various digital devices, doctors and healthcare groups can collect and analyze patient vitals on an ongoing basis, between regular office appointments. Any patient covered by Medicare Part B can enroll in remote monitoring services. It pays for 80% of this benefit. Many secondary insurances will make up the difference.
RPM is a monthly billable program. Patients must receive at least 20 minutes of service each month for Medicare to offer reimbursement. Reimbursement is also offered for setup and training related to RPM devices, as well as daily use by patients. We’ll cover this further below.
As the name suggests, services are delivered through remote interactions. Patients take devices home with them, and they collect readings daily, which are then digitally transmitted to their provider.
These readings can include:
- Blood pressure
- Weight
- Blood glucose
- Heart rate
Data should be collected through a resource that is compliant with the Health Insurance Portability and Accountability Act (HIPAA), such as care coordination software.
Providers, on average, receive $52 for 20 minutes of service per month. Additional opportunities to meet higher billing thresholds are available, as we will detail below.
Providers may also receive an additional $56 per month when patients use their RPM devices daily.
5 Best Practices for Starting an RPM Business
As you strategize or conceptualize your RPM business, it’s best to take certain practices into consideration.
1. Know and Understand General Business Requirements
Whether you’re opening a car wash or launching a start-up, general business elements should be top of mind.
This will ensure your venture is logistically squared away.
For instance, have you determined who your potential customer base is? Will you serve a specific region or provide national coverage? What’s your inevitable tax burden?
More importantly, what client leads do you already have?
Asking these questions will help you prepare. They may also help you understand the potential of your business, as well as further influence your vision of it.
Overall, there’s great benefit in taking the time to prepare. A simple Google search will show you what to do before starting a business.
2. Know the Cost of Acquiring RPM Devices
Aside from staffing, marketing, the necessary tools, and paying yourself, what other costs should you consider before you launch your RPM business?
Namely, you should be mindful of the expense related to RPM devices, themselves.
You could spend anywhere from $100 to $200 on particular gadgets. If so, how will you recoup this cost?
Medicare’s monthly $56 reimbursement for daily patient device use will typically pay for the expense within a few months. Or, will you pass the expense onto your clients?
You’ll want a plan in place and a way to account for this hefty upfront cost. Maybe leasing RPM devices is a better option for you? Leasing is usually a smaller start-up expense.
Either way, be mindful of this aspect as you begin. The cost of RPM devices can become a burden if not approached in a considerate way.
3. Develop a Process and Hire Your Care Team
You should develop a process by which your company will actually provide RPM services. This process should detail the logistics of running the program.
It should include managing enrollment, consent forms, scheduling, and other patient monitoring activities.
Integral to this process is your care team — the people who will actually interact with patients on behalf of your clients, the medical providers.
You’ll need to hire and prepare your staff, which includes at least one care manager. This designated resource can typically work with 100 to 250 patients per month. This range is based on feedback from providers who offer RPM services.
It would be best to hire based on your expected patient population.
An RPM manager should either be a practitioner or a certified resource, such as a:
- Registered Nurse
- Licensed Practical Nurse
- Certified Medical Assistant
- Health Coaches (in some areas)
Hiring a certified and knowledgeable staff will introduce various skills and perspectives to your business, ensuring that the process you create is executed well.
4. Think About Effective Patient Engagement
What is the best way to engage patients after they are enrolled in RPM?
There are various strategies you could apply. It may make the most sense, though, to focus on high-risk patients. They stand to benefit the most from remote monitoring services.
Effectively communicate how exactly these services will help.
For example, by limiting the amount of time someone needs to spend in a doctor’s office, the less exposure they’ll have to other individuals who may be sick. As well, daily participation in monitoring services will, in the long run, arm their care provider with thorough information about their health.
This will aid in care decisions and improve the likelihood of successful treatment.
A patient portal can be extremely effective for patient engagement.
A patient portal allows the patient to view their data. It also improves coordination between patient and provider, and it allows for a focused monthly touchpoint.
Without effective engagement, RPM services provide limited benefits to your patients.
5. Be Aware of Billing and Reimbursement Codes
There are five, necessary items required when submitting a claim through Medicare:
- CPT Codes for each program you’re managing for the patient
- ICD-10 codes tied to each of the conditions you’re managing within that program
- Date of service
- Place of service
- Provider name
While it’s not needed, it is helpful to know the care manager assigned to a patient in case you’re ever audited:
When billing, you’ll calculate the time spent on RPM for each patient monthly. These are the steps you’ll take when billing:
- Verify Medicare requirements were met for each patient each month
- Submit claims to Medicare monthly
- Send an invoice to patients receiving RPM services monthly
- Make sure there are no conflicting codes that have been billed
Below is a breakdown of the RPM reimbursement structure your business can use. The following rates are based on national averages for 2022, which may vary by the locality:
- For initial setup configuration of devices: bill CPT code 99453 for a total of $20.00
- For the provided device with daily monitoring: bill CPT code 99454 for a total of $56.00
- For 20 minutes: bill CPT code 99457 for a total of $52.00
- For anything beyond 20 minutes: bill CPT codes 99457 ($52.00) and 99458 ($40.00) as many times as is appropriate for additional 20-minute increments
Note: For CPT code 99453, you may only bill it once per device. You would not be able to bill 99453 twice in one month, even if you gave the patient two devices that month.
For example, if you gave a patient a blood pressure monitor in January, you may bill CPT code 99453 for January. If you then gave the patient a digital scale in February, you may then bill CPT code 99453 for February.
Note: CPT code 99454 may only be billed once, no matter how many devices the patient is using.
Streamline RPM Services With Intuitive Software
Digital software solutions are available to help your practice embrace integrated, coordinated care. At ThoroughCare, we’ve designed our care coordination software for easy clinical use with an intuitive interface that allows you and your team to engage patients through multiple care management and wellness programs, such as RPM.
We offer extensive training opportunities and learning resources. Our tech support team is readily available, and we integrate with several of the leading EHR providers. Our software modules are designed exactly to federal rules and regulations, and they’re easy to use and understand.
