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Remote Patient Monitoring

A Comprehensive Guide to
Remote Patient Monitoring

Learn about the benefits and requirements of this Medicare program.

What is Remote Patient Monitoring?

A way to manage conditions
with continuous patient data

RPM enables daily measurement of patient health data, including vitals. Providers can assess and use this information to monitor trends and inform long-term care of chronic conditions. 

Along with ongoing data analysis, RPM includes monthly access to care management services, such as:

  • Individual care planning
  • Engagement with the care team
  • Prescription refills
  • Referrals to providers
  • Physician reviews
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RPM engages patients at home

Remote Patient Monitoring presents a unique opportunity for patients not seen previously in healthcare.

Technology-based monitoring and engagement in the home allow patients to experience stronger access to providers. They're given more continuous oversight and care, timely interventions, and convenience and security.

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Providers use RPM to oversee common chronic conditions

Remote monitoring data can enhance care for, but not limited to:

  • Cardiovascular disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Hypertension
  • Sleep apnea
  • Weight loss or gain

Read an Article

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Patients benefit from continuous monitoring, alerting them of risks

Apart from ongoing care team engagement, Remote Patient Monitoring captures patients' long-term health data, allowing providers to set parameters for measurements and readings. 

Patients can benefit from proactive attention to their conditions, helping them avoid hospitalizations or readmissions. 

Qualified providers span care teams

RPM billing must be directed by a provider with an NPI number. That said, a diverse set of licenses can deliver the program, including:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Certified nurse midwives
  • Clinical nurse specialists
  • Pharmacists
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Eligibility depends on requirements

A patient must have a chronic condition to enroll in an RPM program. This disease must: 

  • Be expected to last at least 12 months or until end-of-life
  • Post a risk of death, acute decompensation or functional decline
  • Be noted by the provider 12 months prior to enrollment

How do patients enroll in RPM?

Enrollment is completed at an in-person evaluation or Annual Wellness Visit. Written or oral consent must be documented.

The provider should explain to the patient:

  • How RPM can benefit them
  • Medicare Part-B's 80% coverage with co-pay
  • That they can opt out at any time
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Understanding Remote Patient Monitoring CPT codes:
99457, 99453, 99454, and more

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How do they work?

Remote monitoring CPT codes correspond to an exact activity, whether that be device setup or providing care services.

The codes reflect different rates, each with its own restrictions.

Providers, on average, receive $48.14 for 20 minutes of service per patient per month (99457). Additional opportunities to meet higher billing thresholds are also available. For example, an additional $46.50 per month is billable when patients utilize their RPM device daily (99454).

Best practices

  • CPT code 99453 (device setup): This can be claimed only once per device, and it cannot be billed more than once per month per patient. For example, if a patient receives two devices within the same calendar month, only one device can be billed for in that timeframe. The second device would be billable in the subsequent month.
  • CPT code 99454 (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. 

It is important to note: CPT code 99454 (device use) can be billed every 30 days while codes 99457 and 99458 (program time) are calendar month codes. Aligning claims submissions for these codes is recommended. 

We would suggest submitting all RPM-related claims together by calendar month.

To bill for RPM, providers must meet specific requirements

Delivered either by phone or a telehealth platform, RPM is billable when at least 20 minutes are spent with the patient performing appropriate tasks. RPM services can include:

  • A monthly clinical review
  • Telephone calls
  • Physician reviews
  • Referrals
  • Prescription refills
  • Chart reviews
  • Scheduling appointments or services

Providers can successfully submit
Remote Patient Monitoring claims by:

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How to start an RPM program

Before starting a program, it's important to consider: 

  • Your plan to enroll and deliver services to patients
  • Hiring a certified care manager
  • Targeting a specific population or conditions
  • Using software for care planning, data collection, and billing
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Initial steps to launching an RPM program

Apart from understanding RPM's rules and requirements, providers should:

Care managers engage patients and facilitate RPM program services

Care managers play a crucial role in delivering remote monitoring services to patients. They conduct a majority of patient engagement and execute nearly all program services.

Remote Patient Monitoring devices capture patient data from home

RPM devices collect daily vital data and send it to the provider for ongoing review. Devices must meet criteria for a designated medical device, as determined by the Food and Drug Administration.

These can include:

  • Blood pressure monitors
  • Glucometers
  • Heart rate monitors
  • Pulse oximeters
  • Spirometers
  • Thermometers
  • Weight scales

What is considered RPM data?

RPM data can include:

  • Weight
  • Blood pressure
  • Blood glucose
  • Heart rate

RPM data should be collected through a resource compliant with the Health Insurance Portability and Accountability Act.

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Primary care providers lead RPM adoption for chronic conditions

Data collected and analyzed by Definitive Healthcare indicate that cardiologists and primary care physicians are the main RPM adopters, with nephrologists, pulmonologists, emergency medicine, and pain management specialists making up a smaller but influential group.

Conditions like heart disease, diabetes, and chronic lung disease are not only the deadliest chronic illnesses in the US, but the most prevalent monitored via RPM.

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Data enables early detection

In the specialist care setting, RPM devices can target specific conditions and clinical measures.

RPM data provides an early detection alert when a patient’s clinical picture worsens, but symptoms haven’t surfaced yet.

An adult oncology hospital-at-home program found that during the first 30 days of enrollment, patients in the program were 58% less likely to be admitted for an unplanned hospital stay. 

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At-home access for rural care

For rural health clinics, RPM helps fill gaps in care. Research demonstrates RPM’s efficacy in rural settings, particularly for diabetes, heart failure, and chronic obstructive pulmonary disease (COPD).

An RPM program can also capitalize on providers’ strengths in nurturing personal relationships and maximizing limited resources. They can leverage close ties to the community and collaborate toward quality improvement efforts.

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Using HCPCS code G0511 for RPM

Rural health clinics and federally qualified health centers utilize this HCPCS code for "general care management” to bill for Remote Patient Monitoring.

This code can be billed for multiple care management services per month, including Chronic Care Management and Behavioral Health Integration. However, all service requirements and accounting must be met separately. 

Read an Article

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Remote Patient Monitoring promotes value-based care

RPM can be a versatile tool to maximize care quality and performance.

Though it's a fee-for-service program, RPM can help providers address value-based care objectives without sacrificing financial stability.

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RPM programs enable comprehensive care coordination

Enrollment in RPM provides patients access to individual care planning, monthly touchpoints with the greater care team, referral services, prescription refills, and physician reviews. 

Providers can use RPM programs to seamlessly coordinate care.  

Read an Article

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MetaPhy Health uses software to deliver Remote Patient Monitoring

Since 2017, ThoroughCare has helped MetaPhy Health optimize care delivery for patients with multiple chronic conditions. 

Learn how MetaPhy Health uses our care coordination platform. 

Watch a Case Study

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RPM can be combined
with other Medicare programs

This can further support patient outcomes and generate additional reimbursement.

RPM + Chronic Care Management

Medicare covers patients enrolled in both programs, incentivizing providers to deliver comprehensive chronic disease management.

Collecting and sharing biometric and patient-reported data enables care teams to look for concerning trends and shift tactics when necessary. Also, having real-time notifications that clinicians and patients can review informs care from daily living, not just periodic appointments or estimates over the phone.

Health plans play a critical role
in Remote Patient Monitoring

According to America’s Health Insurance Plans, healthcare organizations are seeing evidence of reductions in utilization, readmissions, and on-call visits, as well as increases in member satisfaction.

RPM claims grew by nearly 1,300% over the last three years.

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Pharmacies can increase access to Remote Patient Monitoring

Providers can partner with pharmacies for program delivery

Primary care shortages, value-based contracting and increasing chronic illness call for pharmacists to have an expanded role. 

Through partnerships, providers can work with pharmacies to streamline care management and improve patient engagement.

Pharmacists are uniquely positioned and skilled for RPM

  • Accessibility: Ninety percent of people in the US live within five miles of a community pharmacy.
  • Frequency: Patients interact with their pharmacist up to 12 times more frequently than their primary care physician.
  • Skills: Pharmacists have counseling and education skills that support RPM activities.
  • Chronic illness: Pharmacists understand many aspects of chronic diseases and their interactive influences.
  • Drug therapy: Pharmacists are drug therapy management experts, which is crucial because most chronic illnesses require multiple medications.

Read an Article

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Software enables Remote Patient Monitoring

Capture and analyze patient health data continuously to inform condition manage, monitor risks, and report and track overall wellness. 

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ThoroughCare streamlines
Remote Patient Monitoring

Our software platform is intuitive and designed for RPM’s rules and requirements. ThoroughCare can help:

  • Facilitate patient consent and enrollment
  • Integrate with RPM devices to capture data
  • Visualize data with analytics for actionable insight
  • Create and maintain goal-driven care plans
  • Simplify claim submission and documentation requirements

Request a Software Demo View Solution

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