If you’re a healthcare provider wondering how remote patient monitoring works, you can benefit from this remote patient monitoring complete overview. This guide covers everything you need to know, including how remote patient monitoring works, who performs RPM services, and how to bill for it. Additionally, you receive a CPT Code reference list, learn how technical support for rpm works, and how to get started with RPM.
How Remote Patient Monitoring Works and What it is
Remote patient monitoring (RPM), also called remote physiological monitoring or remote patient management, monitors specific aspects of a patient’s health from home. RPM can help manage conditions such as sepsis, atrial fibrillation, and COPD. As a result of this remote health technology, RMP usage increased dramatically during the COVID-19 pandemic.
Accordingly, remote patient monitoring helps engage and empower patients while improving adherence to treatment plans. Additionally, RPM is often called remote patient management or physiologic monitoring. Patients submit their vital statistics to providers to measure physiologic data such as a patient’s heart rate, weight, oxygen saturation, pulse rate, glucose levels, and more.
With this consistent data stream, providers see a complete overview and record of patient vital signs. Furthermore, providers have many choices in FDA-cleared remote patient monitoring devices.
Who Can Perform RPM Services?
Remote patient monitoring services are completed by a physician, qualified healthcare professional, and auxiliary personnel (i.e., clinical staff) incident to the billing practitioner’s professional services. With this in mind, a physician must document adequate justification for prescribing RPM in the patient’s medical record. Remote physiological monitoring services must meet the acute care or chronic condition criteria.
How Remote Patient Monitoring Works
First, to understand how remote patient monitoring works, you’ll want to understand the role of IoT health monitoring devices. The sophistication of FDA-cleared remote patient monitoring hardware devices and RPM software platforms vary. RPM data is generally collected manually and entered by a remote patient monitoring system. Some RPM devices automatically gather vital health data via cellular or Bluetooth technology, which makes the process significantly easier for patients. Data from the medical device is collected and securely transmitted in real-time to the healthcare provider’s location for further updating assessment and patient intervention.
Remote Patient Monitoring Complete Overview: 5 Steps to Set Up RPM
In recent years, the Centers for Medicare & Medicaid Services (CMS) implemented several changes to help understand how remote patient monitoring works regarding reimbursement. CMS has helped healthcare providers overcome barriers to coverage, billing, and payment for RPM services. Thus making it easier for chronic care management (CCM) patients to receive virtual care. Below is a step-by-step remote patient monitoring overview outlining how to start setting up remote patient monitoring procedures for Medicare reimbursement.
Step 1: Patient Opt-In
First, the patient must opt-in to remote patient monitoring services. If the physician has not had a face-to-face interaction with the patient in over one year or if the patient is new, RPM services must be initiated in person. Medicare beneficiaries are subject to a copay for remote patient monitoring services.
Step 2: Ordering the Device and Setup
Next, the physician orders the FDA-cleared remote medical device for the patient. Vital sign monitoring devices include scales, blood pressure monitors, blood glucose meters, and pulse oximeters. Some remote patient monitoring outsourcing providers will ship RPM devices directly to patients.
Step 3: Patient Use of Device
Third, patients must use their remote patient monitoring device for at least 16 days per month in a 30-day period to bill for CPT does 99453 and 99454. Physicians can set parameters for each patient. Once these are set, the physician is automatically alerts the care provider if the reading is outside those parameters. Every time a patient uses the device, the reading is sent in real-time to the clinician portal. There, the clinician can access all of the patient’s previous recordings.
Step 4: Data Analysis & Interpretation
To bill for data analysis, the physician, qualified healthcare professional, or clinical staff must perform 20 minutes of remote patient monitoring services per month. That 20 minutes must involve live, interactive communication with the patient. This can be completed remotely via video, text, or phone call.
Step 5: Submit the Claim
Finally, clinicians must keep a record detailing services performed and how much time was spent. They must send this documentation when billing Medicare. Remote patient monitoring services can include:
- Data review
- Interactive communication with the patient
- Creating/ adjusting treatment plans
Timing does not round up. For example, if a care provider performs 35 minutes of RPM services, the billing physician only pays for the initial 20 minutes. At the end of each billing period, the billing physician submits the claim for reimbursement. The billing physician can also wait until the end of the month to submit all claims.
How Remote Patient Monitoring Works in Billing
According to research published in JAMA Internal Medicine, Medicare remote patient monitoring use surged during the COVID-19 pandemic. Researchers report that remote patient monitoring use among Medicare beneficiaries increased from 91 claims per 100,000 enrollees in February 2020 to 594 claims per 100,000 in September 2021.
Medicare patients are one of the primary groups of patients who can benefit from RPM. Therefore, Medicare recognizes the value of remote patient monitoring services. To incentivize providers, Medicare created a set of 5 CPT Codes: 99453, 99454, 99457, 99458, and 99091. Below is an explanation of the CPT codes and a complete overview of the remote patient monitoring Medicare reimbursement process. However, the CMS Medicare final Rule 2024 reimbursements per code are expected to be available in early December 2024.
Remote Patient Monitoring Complete Overview of RPM CPT Codes?
Each CPT billing code allows providers to document and bill for non-face-to-face device setup, remote monitoring, treatment management, collection analysis, and interpretation of physiologic factors. These factors are used to understand a patient’s health status.
CPT 99453 Device Setup
$19.65 for at least 16 days of monitoring in a 30-day period.
This remote patient monitoring CPT code bills for initial setup and patient education on equipment for vital sign monitoring such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate, and weight. This one-time payment (per patient) is billed after the initial 16 days of monitoring in a 30-day period.
CPT 99454 – Remote Monitoring
$46.50 at least 16 days of monitoring in a 30-day period.
Healthcare providers submit CPT code 99454 monthly for supplying patients with an FDA-cleared RPM device. Additionally, physicians can set parameters for each patient. As a result, healthcare providers receive an alert if the reading is outside those parameters. This code is billed every 30 days by one clinician, given that the device is used for at least 16 days per 30-day period.
CPT 99457 – Treatment Management
$48.14 in a 30-day period
In a calendar month, this CPT code is submitted for the initial 20 minutes of treatment management services by clinical staff, physicians, or other qualified healthcare professionals. The code can be billed over a 30-day period..
Moreover, CPT 99457 can be billed ‘incident to’ under general supervision. Medicare providers can contract third-party companies to assist with RPM services. Ultimately, the clinic will be able to manage more patients and generate more revenue without significantly impacting workflow.
CPT 99458 – Additional 20 Minutes of Remote Monitoring
$38.64 in a 30-day period
RPM CPT Code 99458 is submitted for additional cumulative 20 minutes of RPM services, with a maximum of 60 minutes over a 30-day period.
CPT 99091 – Collection and Interpretation of Remote Data
$52.71 in a 30-day period
This code covers the time it takes clinical staff to gather, interpret, and process data, at least 30 minutes over a 30-day period. This does not require interactive communication with patients.
It is important to note that these rounded numbers are based on non-facility national averages and vary by region.
Remote Patient Monitoring Complete Overview of Technical Support and Setup
Several remote patient monitoring services offer technical support for patients using RPM devices. With Tenovi devices, there is no app or syncing required. This means that healthcare providers automatically and securely receive patient measurements within seconds. Here is a complete overview of this in just 3 Easy Steps.
Step 1: The Patient Takes a Measurement
Choose from a growing list of FDA-cleared RPM medical devices with industry-leading accuracy. Devices can monitor vital signs such as blood pressure, weight, blood glucose, and pulse.
Step 2: Patient Vitals, Transmit Automatically
Using cybersecurity encryption and authentication, Tenovi Cellular Gateway uses cellular technology to send patient data to the Tenovi HIPPA-compliant cloud automatically. Patients receive non-obtrusive visual reminders to help improve adherence.
Step 3: The Care Management Team Reviews RPM Data
If patients have technical support needs, Tenovi has a dedicated team of consultants available to provide patients with RPM device onboarding and HIPPA-compliant RPM technical support. Providers may also use the Tenovi RPM Dashboard or send data directly to their software platform through Tenovi’s application programming interface (API). Tenovi offers client technical support for RPM hardware and software.
Remote Patient Monitoring Complete Overview: Key Points
Telehealth services, such as remote patient monitoring, help optimize preventive care outcomes by focusing on early intervention and timely treatment. Patients take their vital signs and measurements from the comfort of their homes, eliminating the need for transportation, travel costs, and long wait times. Fortunately, telehealth accreditation and certificate programs are available for healthcare professionals and organizations new to navigating these new technologies.
Additionally, clinicians use the accumulated health data to better care for their patients and promptly intervene as necessary. Now that you have a remote patient monitoring complete overview, the next step is developing an RPM program that meets your patient and healthcare team’s needs. If you want to enhance preventive patient care, request a free RPM demo.
