Frequently-asked questions (FAQ)
FAQ on Remote Patient Monitoring, Population Health, Chronic Care Management, Telehealth, TCM, PCM and CareSimple
Remote Patient Monitoring
What is digital health?
Digital health is, quite simply, the future of healthcare.
Just like the finance industry that digitized first its banking operations, then the consumer with ATMs and further down the road online and mobile banking portals and apps respectively, healthcare first digitized medical records inside the hospitals and physician groups but nowadays with RPM are starting to extend the digitization to remote care for patients to enjoy care from the privacy and comfort of their home or office.
New technologies are fundamentally changing the way people interact with health care just like consumers have discovered the benefits of shopping online. The landscape of digital health technology spans from virtual care and hospital clinical efficiency solutions like EHRs to data management, AI applications and population health digital services, and everything in between.
What is telehealth?
Telehealth is an all-encompassing, broad term that can be defined as the delivery of health care or health-related services through technology. It can occur over long or short distances.
Until very recently, telehealth was used mainly in situations where patients faced physical or financial barriers to accessing quality healthcare. Post-pandemic, however, telehealth is much more popular regardless of distance and barriers.
What is telemedicine?
Telemedicine refers to a clinician providing healthcare services to a patient outside the traditional exam room or healthcare facility.
So, telemedicine is actually just one component of telehealth.
What is remote patient monitoring?
Remote patient monitoring (RPM) is the remote collection of patients’ physiologic measures using connected devices that patients use at home or office—blood pressure cuffs, body scales, heart rate and pulse oximetry monitors, blood glucose monitors, spirometers and mobile apps—with the dashboards, clinical alerts and secured messaging that care managers use to deliver the remote care services. It also incorporates the data processing, secured storage and analysis that occurs in between data collection and reporting. RPM is now an essential service to empower population health effectiveness.
How does Remote Patient Monitoring (RPM) work?
Patients are first onboarded on the RPM program by being provided with an FDA approved medical device that they can use at home to self-measure parameters such as weight, blood pressure, oximetry and blood glucose to name a few. The type of measure and their frequency is prescribed by the clinician through the care plan. A care manager under the general supervision of the physician reviews the patient measurements during the month, exchanging with the patient on their compliance, medication adjustments or other related care topics. Each patient is therefore monitored for chronic or acute conditions outside of the traditional clinical settings.
Why launch a Remote Patient Monitoring program?
RPM is a triple win service that rewards all stakeholders: patients, providers and payers. With RPM, physicians not only keep their patient under control while at home, but also digitize the physician/patient relationship and generate healthy new recurring revenues their practice. According to the AMA, use of RPM in the practice of medicine has nearly doubled in three years, from 13% in 2016 to 22% in 2019. What’s more, 33% of physicians who weren’t using RPM in 2020 are planning to integrate RPM into their practice over the next twelve months.
How can RPM help a brick-and-mortar medical practice?
RPM can help physicians in many ways:
- Provide continuity of care outside the clinical settings
- Engage patients into becoming active participants of their care plan
- Manage population health and embrace value-based care
- While pleasing patients, create entirely new recurring revenue streams
- Service patients where they are keeping safe during the pandemic
Can senior patients use Remote Patient Monitoring Technology?
Absolutely. RPM has many benefits for seniors. Today’s solutions are designed with senior patients in mind and are extremely easy to use for patients and clinicians. In fact, if a senior patient is capable of taking a home blood pressure measurement or weighing themselves, then they are absolutely capable of using RPM technology. It’s that simple. No more pairing, WiFi and complicated setups are now required.
What type of patients can be onboarded on RPM?
Virtually any patient can be onboarded on an RPM program. While Chronic Care Management requires the onboarding of patients with two or more chronic conditions, this limitation does not exist on RPM according to the 2020 CMS Physician Fee Schedule. This is why several large CCM practices select an RPM partner to take care of the technology for them and onboard their CCM patients on RPM. That provides the ability to actively engage these patients while adding a new stream of recurring revenues.
What type of patient consent is required for RPM?
RPM requires the same type of patient consent as any other similar programs. Often, CCM patients already have signed a written consent when they were onboarded on CCM, so a verbal confirmation of the expanded services brought by RPM is often performed at the patient outreach phase over the phone. Others use the RPM patient app to add a patient consent questionnaire as the very first task an RPM patient must complete before entering into further requirements of their prescribed care plan.
Why is 4G better than Bluetooth for Remote Patient Monitoring?
4G, or cellular-based medical devices, offers an easy-to-use advantage over Bluetooth devices. There are no connectivity barriers, and the setup is simple for patients of any technical skill level, which is critical when onboarding senior patients on RPM programs. With 5G now starting to become available, expect this technology to move forward quickly to expand healthcare applications while keeping it very simple for patients and clinicians alike.
How can I make sure patients use the RPM medical devices?
Today’s RPM systems are knowledgeable about billing rules and patient compliance, so they keep track of patients whether they are or aren’t compliant with either their prescribed care plan which is tied to the billing rules. Patient compliance is key to ensure the triple win outcome of an RPM program.
What types of key services should an RPM patient app provide?
An RPM patient app should not be mandatory to engage the patient on an RPM program as some patients do not have smartphone or do not have the technical skills to efficiently use an app. But for the patients that can use an app, it should drive both engagement and compliance, providing insight and education, secured messaging, capturing symptoms and context in a just-in-time manor and mostly it should be kept simple. Patients have enough to deal with from their conditions, the last thing they need is anything complicated on top of it.
What type of RPM medical devices qualify for Medicare purposes?
RPM devices must be FDA approved medical devices, and the patient measurements must be electronically collected by an RPM system to be monitored by the care manager. This means that the medical device should automatically and digitally upload patient physiologic data. The use of the device must also be reasonable and necessary for either the diagnosis or treatment of the patient’s condition, and the data the device captures must allow for an understanding of the patient’s health with a view to developing and/or managing an established care plan.
As of October 2020, measurements reported via questionnaires or directly from an App manual input like Pain and Mood, for example, are not recognized as part of the RPM reimbursement.
Can wearables be used in RPM programs?
While there is nothing that prevents the use of wearables to collect activity and sleep data for example in an RPM program, only FDA approved medical devices are currently entitled to RPM reimbursements so the cost of non-FDA approved wearables becomes an expense from the provider which limits greatly their use in Reimbursed RPM programs. Same currently applies for capitation-based programs.
Other types of RPM programs fueled by other incentives such as payer or governmental initiatives do integrate wearables into their funded RPM programs.
What drives RPM from a financial standpoint?
The main objective of RPM is to engage patients in the care from the privacy and comfort of the home in order to avoid complications and hospital admissions, thus saving healthcare cost on the long term while improving the patient’s quality-of-life.
That being said to drive this objective there’s a need for financial reward of launching the RPM service in the first place. Here are essentially the four key drivers of financial incentives for RPM:
- DIRECT REIMBURSEMENTS
- CAPITATION MODELS
- COST REDUCTIONS
- PAYER INCENTIVES
Does Medicare reimburse for Remote Patient Monitoring?
Yes. Medicare Parts A and B reimburse physicians for RPM. Patients who are in Medicare Part B have a co-pay of 20%. Medicare Advantage patients have a copay that depends on their plan.
The four primary Medicare RPM codes are CPT codes 99453, 99454, 99457, and 99458. You can learn much more about these codes and how to apply them to your practice and optimize your reimbursement by reading our white papers on the topic
Who can provide Remote Patient Monitoring services?
Medicare’s CPT codes for RPM services allow physicians and other qualified healthcare professionals and clinical staff, like registered nurses, to perform RPM: practitioners only need to be licensed by the state.
As of 2020, RPM can occur incident to and under general rather than direct supervision, which means providers can outsource monitoring and billing duties to other staff members or remote care services (RCS) providers external to their practice. This “outsourced” remote care model can free up providers’ time, optimize patient care & compliance, and provide an additional stream of revenue for the clinic.
Is it possible to bill RPM at the same time as Chronic Care Management?
It is possible to bill RPM and CCM for the same calendar month and for the same patient for as long at the clinical time counted as under the RPM program is NOT the same clinical time spend on care coordination activities under the CCM program.
How much data do I need to collect from the patient to be reimbursed?
Monitoring must occur for at least 16 days of a 30-day period in order for CPT code 99454 to be billed: this code can’t be reported for the same patient more than once per patient during a month. It’s also important to note that the services associated with remote patient monitoring can only be billed once during a month even when the patient uses more than one device to collect data and monitors symptoms of more than one chronic or acute condition.
What rules or regulations do I need to follow when implementing an RPM program?
At a minimum, providers must ensure their RPM partner follow HIPAA security and privacy regulations, and that the medical devices their suppliers use are FDA approved. There are also ISO certifications that apply to RPM such as ISO 13485 for Quality and ISO 27001 for Security. It is also recommended to follow the American Medical Association (AMA) guidelines for digital health implementation. The AMA Digital Health Playbook can be found at:
What are the CMS new 2020 rules on reimbursement codes for Remote Patient Monitoring?
The CMS 2020 Physician Fee Schedule for RPM as in “Remote Physiologic Monitoring”final rule was finalized with two important changes, both of which have been effective since January 1, 2020:
- RPM can be furnished “incident to” under general supervision; and
- CPT Code 99458 is a new add-on code for patients who receive an additional 20 minutes of RPM services in a given month (99457 being the first 20 minutes of RPM services clinical time), with a maximum of 60 minutes monthly per patient in a given month.
How do reimbursement codes for RPM work?
The 2020 Chronic Care Remote Physiologic Monitoring codes are as follows:
- CPT code 99453: PATIENT ONBOARDING / Initial; set-up and patient education on use of medical device. The national average payment for 99453 from the CMS 2020 Physician Fee Schedule is $19 per patient onboarding (One-time fee).
- CPT code 99454: TECHNOLOGY / Medical device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. The national average payment for 99454 from the CMS 2020 Physician Fee Schedule is $62 per patient per month (PPPM).
- CPT code 99457: CLINICAL TIME (1st 20 MIN) / Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
The national average payment for 99457 from the CMS 2020 Physician Fee Schedule is $52 per patient per month (PPPM).
- CPT code 99458: CLINICAL TIME (ADDT’L 20 MIN) / Remote physiologic monitoring treatment management services, Additional 20 minutes or more (Max 60 Min) of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
The national average payment for 99458 from the CMS 2020 Physician Fee Schedule is $42 per patient per month (PPPM).
RPM During Pandemic
How did Remote Patient Monitoring rules change under the current pandemic?
Perhaps the most significant boon to implementing RPM in the physician practice environment comes from the recent response to the pandemic as CMS now permits RPM reimbursement for both established and new Medicare patients who receive Evaluation and Management (E/M) services.
Although this is a temporary change permitted via the current Public Health Emergency (PHE) that is slated to revert to a restriction to established patients once the pandemic ends, it possibly heralds a less restrictive environment for identifying patients who require or would benefit from RPM services. For example, because of the pandemic, CMS now permits the use of interactive audio-video in real time, and that encounter satisfies the “face-to-face” requirement of a provided E/M service for new patients for Medicare telehealth services.