Is remote patient monitoring considered telehealth? While remote monitoring and prevailing telehealth platforms enable similar modalities of virtual care delivery, nuances do exhist. Specifically, the Centers for Medicare and Medicaid Services (CMS) adheres to strict definitional criteria regarding which remote healthcare services constitute real-time telehealth vs. alternative virtual interventions.
This article clarifies the distinctions between telehealth and remote patient monitoring under CMS guidelines. We will explore precise specifications around what interactions qualify as reimbursable telehealth coverage under CMS and discuss why remote monitoring falls outside this scope according to regulations. Achieving reimbursement parity across virtual care models that is thoughtfully implemented has vast potential to augment telehealth’s impact on patient outcomes.
What is Remote Patient Monitoring?
Remote patient monitoring (RPM) is a way to track a patient’s vital signs and symptoms outside of the healthcare facility. Patients use remote patient monitoring devices at home to collect health data like blood pressure, temperature, weight, and oxygen levels. This data is wirelessly transmitted in real-time to their healthcare providers for interpretation. The provider is notified to intervene if any data falls outside preset thresholds.
Remote patient monitoring use cases include chronic care management for conditions like diabetes, hypertension, chronic obstructive pulmonary disease (COPD), and congestive heart failure. Remote scales, blood pressure monitors, pulse oximeters, blood glucose meters, and more collect physiologic data for clinicians to monitor at a distance. The goal is to track patients’ overall health and catch any warning signs early to avoid hospitalization.
What is Telehealth?
Telehealth refers to a broader scope of remote healthcare services beyond remote patient monitoring. While definitions vary slightly, telehealth generally refers to using technology to deliver virtual medical, health, and education services. Examples span live video conferencing for provider appointments, transmission of still images, e-consults between providers, and more. Telehealth includes a wider range of healthcare services delivered through technology, with remote patient monitoring as a component.
CMS Does Not Consider RPM to Be Telehealth
Remote patient monitoring is often considered a subset of telehealth. After all, it delivers healthcare digitally from a distance, like telehealth. However, CMS has specific regulations around what is considered telehealth, which excludes RPM. CMS imposes strict regulations on what’s considered telehealth. By CMS’s definition, telehealth must include live video interaction equivalent to in-person for evaluation, assessment, or treatment. Remote patient monitoring does not require live video, so by CMS regulations, it does not qualify as telehealth.
In 2018, CMS introduced CPT codes to reimburse healthcare practitioners who are providing remote patient monitoring services. Therefore, in the clinical billing sense for CMS reimbursement, remote patient monitoring is not considered telehealth. However, in everyday healthcare language, remote patient monitoring is often referred to under the broad umbrella term of “telehealth services.”
Why CMS Makes This Distinction
CMS outlines specific criteria dictating what care delivery models are eligible to be designated telehealth services. Therefore, it is important to remain informed of the billing requirements of each RPM CPT code for a smooth reimbursement process. Live video visits are meant to replicate in-person care, so they’re reimbursed similarly.
RPM is meant for monitoring. Therefore CMS created CPT codes accordingly, which prevents excessive RPM use solely for financial gain vs. clinical need. Additionally, CMS requires an initial in-person visit to establish a treatment relationship before initiating telehealth and remote patient monitoring services. This ensures patients meet with health providers face-to-face to determine the medical necessity for remote services like remote patient monitoring.
Key Takeaways – Is Remote Patient Monitoring Considered Telehealth?
Remote patient monitoring and telehealth deliver patient care digitally from afar. In this sense, RPM enables key virtual care and telehealth aspects for chronic disease management. While CMS may not consider remote patient monitoring a telehealth service, most healthcare providers still consider remote patient monitoring an essential element of telehealth services. This allows medical practices to monitor more patients remotely at greater convenience to improve population health, though CMS payment structures differ.
Whether your healthcare partners are interested in adopting remote patient monitoring to increase patient engagement, create a more efficient workflow, or increase revenue, Tenovi can help you find a better solution. Book a free demo today.
