Remote Patient Monitoring

In recent years, remote patient monitoring (RPM) has become increasingly prevalent. It is no surprise, as this technology enhances the patient care experience while allowing monitoring outside of a traditional clinical setting.
RPM also has the potential to reduce healthcare delivery costs, which makes care more accessible overall. Remote patient monitoring is especially beneficial for managing chronic diseases, tracking physical ailments, and supervising post-hospitalization rehabilitation.

However, many care providers and physicians do not fully understand remote patient monitoring requirements and regulations. These deficiencies have the potential to hinder the implementation of RPM programs and decrease reimbursement. It can even result in non-compliance with the requirements and fee schedule of the Centers for Medicare & Medicaid Services (CMS).

With this in mind, Med USA created this comprehensive guide to remote patient monitoring. The discussion below will cover how patients can qualify for RPM, which states require coverage by insurance companies, and specific billing requirements.
Our goal is to facilitate a better patient care experience by helping healthcare organizations implement successful RPM programs.

What is Remote Patient Monitoring?

Generally speaking, remote patient monitoring refers to the practice of securely documenting, collecting, and exchanging clinical data using remote technology. With these devices, your medical team can remotely monitor patients using tools like:

● Grip strength sensors for Parkinson’s disease
● Musculoskeletal risk stratification equipment
● Calorie-tracking monitors
● Dementia surveillance cameras
● Oximeters
● Blood pressure cuffs
● Heart rate monitors
● Glucose meters

The specific array of devices issued to a patient will depend on the condition(s) from which they suffer. For instance, a patient who has been diagnosed with diabetes, hypertension, and dementia will likely be outfitted with multiple pieces of RPM equipment.

By using remote patient monitoring devices, your staff can closely monitor patients without having to bring them into the office or admit them to a long-term care facility. Staff members can rapidly determine whether the patient is stable, improving, or suffering deterioration and in need of emergency care.

Many Americans are already using self-monitoring tools, such as smart devices and self-purchased equipment. A remote patient monitoring program replaces these devices with medical-grade equipment and facilitates secure information sharing between patients and medical professionals.

Is Remote Patient Monitoring the Same as Telehealth?

The phrase “telehealth” is a broad term used to describe the entire remote care industry. Telehealth includes video conferencing, phone conversations, and other means of communication. Remote monitoring platforms fall under the larger umbrella of telehealth.

Your organization does not need to offer a full suite of telehealth services to incorporate RPM into its current care practices. Remote patient monitoring can be introduced as a standalone service inside the scope of care already provided by your staff.

How Patients Qualify for RPM

Historically, remote patient monitoring was limited to individuals who suffered from chronic conditions. However, the COVID-19 pandemic created a huge surge in demand for remote care across all patient groups.

In response, the federal government and CMS expanded their coverage of RPM services to include both chronic and acute conditions.

Despite these changes, chronic conditions are still the primary driver of remote patient monitoring technologies, as patients in this category often require prolonged care.

Chronic

Physicians and other care providers can monitor any chronic disease or acute condition with RPM technologies. However, certain ailments tend to benefit more from remote patient monitoring solutions. Some of these conditions include:

● Diabetes
● Congestive heart failure
● COPD
● Hypertension
● Dementia
● Obesity
● Behavioral health

Patients diagnosed with these conditions require ongoing monitoring to allow healthcare teams to readily identify any changes in status. Care team professionals must detect sudden deterioration quickly and provide a proactive medical response.
Through remote patient monitoring, your care team will be better equipped to respond to the types of unexpected medical events that these patients may encounter.

Acute

While this usage is less prevalent, acute conditions can also be monitored using RPM technologies. The COVID-19 virus and its related health effects were a primary factor in the current expansion of remote patient monitoring coverage.

This amendment to CMS’ RPM requirements means that care team members can now monitor patients who are suffering from the following conditions remotely:

● Respiratory infections
● Pneumonia
● Heart attacks
● Flu
● Severe burns
● Bronchitis
● Severe injuries that result in limited mobility

Your staff can consider implementing RPM devices into the care plan when they are treating patients for the conditions listed above, as well as others. However, some requirements limit when and how you can bill for RPM services. We will discuss these restrictions in greater detail below.

Before utilizing remote patient monitoring equipment for acute care, your staff should consider specific patient factors. Care teams should determine whether the patient is at an increased risk of experiencing severe complications, has had difficulty attending face-to-face appointments, and whether they are likely to experience symptoms for a prolonged period of time.

As always, physicians and other care professionals should decide to use RPM solutions on a patient-by-patient basis. An individual analysis will help your team choose the best care strategy for each patient’s unique needs.

States that Require Coverage for Remote Patient Monitoring

Currently, remote patient monitoring is not mandatory coverage in all 50 states. However, many health insurance providers are adding RPM to their covered service lists because it is extremely cost-effective.

In addition, the CMS has drastically expanded its policy regarding remote patient monitoring coverage. It remains to be seen whether they will scale back this coverage in the future, after the large expansion prompted by the COVID-19 pandemic.

As is often the case, several states are being proactive in updating their healthcare regulations. Specifically, fifteen states, along with Washington, D.C., have implemented legislation requiring health insurers to provide coverage for RPM services.

The states that have passed such laws include:

● Arizona
● Arkansas
● Colorado
● Connecticut
● Georgia
● Maine
● Maryland
● Massachusetts
● Mississippi
● Nebraska
● New Hampshire
● New Jersey
● New Mexico
● Virginia
● West Virginia

Some of these states have implemented broader legislation to require healthcare insurers to cover RPM services and telehealth solutions, while others have limited the legislation to address remote patient monitoring exclusively.

In the coming years, more states will likely implement RPM coverage mandates. Such coverage increases will expand the already surging demand for remote patient monitoring technologies and software.

State legislators are not the only ones that are becoming more conscious of the benefits of remote patient monitoring solutions. Patients are also expressing a desire for access to remote healthcare technologies on a large scale.

Rising patient demand means organizations should strongly consider implementing remote patient monitoring solutions if they do not already have them in place. Doing so will drastically enhance the care experience, save money, and streamline data sharing.

Equipment Covered by RPM

As expected, increased demand has resulted in rapid advancements to RPM technologies. Remote patient monitoring devices have become more reliable and user-friendly. They have also been reduced in size to make them more convenient for patients.

When implementing your remote patient monitoring program, it is important to understand what types of devices are included in this coverage. Typically, CMS and private insurers will cover a broad range of patient monitoring devices, as long as they are relevant to the patient’s diagnosis.

Some of the most common types of equipment that are covered by RPM include the following:

Weight Monitoring Equipment

As you treat individuals with obesity and weight-related health disorders, your team can request remote patient weight monitoring equipment. This equipment may include a high-quality digital scale that will relay information about your patient’s weight during daily check-ins.

When paired with other patient monitoring equipment, scales can provide valuable insights into an individual’s progress.

Remote patient weight monitoring devices are also valuable for treating patients with congestive heart failure or diabetes. Sudden increases in weight may be an important indicator that your team needs to identify, allowing them to make adjustments to the care plan and address the situation quickly.

Blood Pressure Monitors

Blood pressure monitors are a valuable piece of RPM equipment for a variety of patients. Individuals who are suffering from hypertension, diabetes, congestive heart failure, and obesity may benefit from regular blood pressure monitoring. This equipment is covered by virtually every remote patient monitoring program.

Spirometers

Spirometers are much less common in terms of remote patient monitoring. However, they are a vital piece of equipment for individuals suffering from conditions such as COPD.

By giving patients the ability to perform at-home pulmonary function tests, they can continuously gather data on their disease. Your team can use that information to assess their condition.

Blood Glucose Monitors

Poor blood glucose monitoring habits can be detrimental to the health of diabetic patients. Fortunately, blood glucose monitors are covered by remote patient monitoring policies.

Remote glucose monitoring allows you to give patients the tools they need to closely monitor their diabetes. Your care team will also be able to track and review daily readings to provide dietary recommendations.

Over time, your providers will also be able to help patients better manage their diabetes. Advancements in this technology can improve the long-term prognosis for diabetes sufferers while also enhancing their quality of life.

Oximeters

Oximeters are another affordable remote monitoring device that is often covered by RPM policies. Instead of relying on subjective notions of feeling, patients will gather real-time data on their oxygen levels.

Your care team will have instant access to this data, as well. Timely access will allow team members to detect irregularities and deterioration in patients suffering from conditions such as COPD.

Digital Thermometers

Digital thermometers are generally included in remote patient monitoring coverage. While these devices are readily available at most stores, some patients on extremely limited incomes may be unable to afford them.

By covering digital thermometers in their expanded RPM policy, CMS took another step towards enhancing patient access to healthcare services.

Emergency Alert Wearables

The rise of smartwatches led to the creation of emergency alert wearable technologies. These devices are an asset to elderly patients and those who suffer from severe mobility restrictions.

Remote patient monitoring wearables allow users to contact your team and local emergency medical care providers in the event of a serious health event, such as a slip and fall injury.

CMS and many private health insurers cover remote patient monitoring wearables. They are typically issued to patients with a history of falls and individuals diagnosed with degenerative conditions that affect mobility.

Requirements on How to Bill for RPM

It is essential to understand the CMS billing requirements before implementing your remote patient monitoring program. If your organization opts to expand an RPM program to include privately insured patients, many of these requirements will also apply.

However, each private insurer has slightly different regulations, which means that you will have to assess RPM eligibility on a case-by-case basis.

Patient Opt-in Required

Similar to other forms of care, patients must opt in for remote patient monitoring services. If the patient opt-in process or forms do not comply with CMS regulations, they may deny the claim.

As with other documents, the opt-in form must require positive action on the part of the patient. This could include checking a box, signing or initialing a physical document, or providing an electronic signature.

When you’re implementing a remote patient monitoring program, consult with your legal department. They will ensure that your opt-in form complies with CMS regulations.

If you have any questions or concerns about the opt-in process, contact Med USA for further assistance.

Devices Must Meet “Medical Device” Definitions

According to the FDA, a medical device is:

“an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part or accessory which is recognized in the official National Formulary or the United States Pharmacopoeia, or any supplement to them.”

The FDA also requires a medical device to be:

“intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.”

Before deciding to issue a remote patient monitoring device to an individual under your care, ensure that equipment meets the definition above. Proprietary technologies that governing bodies do not recognize will not be eligible for billing under the CMS remote patient monitoring regulations.

RPM Must Be More than 16 Days

Based on the current CPT language, remote patient monitoring must occur for a minimum of 16 days during a 30-day billing period to apply RPM billing codes.

In addition, the primary RPM billing codes of 99453 and 99454 cannot be applied to the same patient’s account more than once in any 30-day period. This rule applies even when providing a single patient with multiple devices.

CMS has stated that CPT code 99453 can only be billed once per episode of care. The Centers for Medicare & Medicaid Services defines an episode of care as “the set of services provided to treat a clinical condition or procedure.”

For instance, if you issue a patient RPM device on September 1. The projected billing period should span from September 1 until September 30.

You could not bill using the RPM codes 99453 or 99454 unless that individual received remote patient monitoring services for at least 16 days. If they received said services for 15 days or less, the billing operator for the care team must utilize other billing codes.

Devices Must Sync Data Wirelessly

While it may seem like a given, CMS remote patient monitoring regulations require that all data be synced wirelessly. Without the sending and receiving of data, RPM has not occurred, according to CMS guidelines.

For instance, the patient cannot take their blood pressure manually and verbally report this data to your staff. They cannot document the data using a portable digital device and then return it to your office for manual download.

When you’re deciding which types of equipment to incorporate into your RPM program, ensure that the devices wirelessly transmit data. Otherwise, you will have difficulties properly billing for remote patient monitoring services.

The purpose of this requirement is to maintain the purpose of RPM care. If the devices do not streamline the sharing of patient data and facilitate remote monitoring, they are not fulfilling the purpose of enhancing access to healthcare.

Manual and portable non-wireless devices would also do little to streamline the communication between your staff and patients.

Qualified Clinicians Must Perform RPM

The Centers for Medicare & Medicaid Services defines clinicians as those who provide:

“principal care for a patient where there is no planned endpoint of the relationship; expertise needed for the ongoing management of a chronic disease or condition; care during a defined period and circumstance, such as hospitalization; or care as ordered by another clinician. Clinicians may be physicians, nurses, pharmacists, or other allied health professionals.”

For billing purposes, remote patient monitoring is classified as an evaluation and management (E/M) service. That is why CMS restricts the billing of these services to clinicians as defined above.

Remote Patient Monitoring Billing Codes

The U.S. medical system relies on five-digit current procedural terminology (CPT) codes for billing purposes.

Remote patient monitoring has its own set of designated billing codes that must be utilized when processing services rendered. When they are used improperly, CMS will require your organization to make corrections. Otherwise, it may deny claims entirely.

Almost all remote patient monitoring services are billed using one of three CPT codes. The codes employed for reporting RPM services provided to patients under care are as follows:

99457

The CPT code 99457 is utilized for general remote physiologic monitoring services lasting for 20 minutes or longer. This time is accumulated throughout the entire billing cycle (30 days) and is not calculated on a per-interaction basis.

Billing agents for care teams should use this code to bill for interactive communication between your staff and the patient during the specified month. CPT code 99457 is designated for the time it takes for your team to review and interpret data.

Care teams can use code 99457 in conjunction with CPT code 99490. CMS views remote patient monitoring data interpretation and analysis as a supplement service to comprehensive chronic care management (CCM).

However, you cannot “double count” time. To legitimately bill both codes, your care team must have provided a minimum of 40 minutes of services during the month.

99453

The CPT code 99453 is designated for the initial implementation of remote patient monitoring services. Initial implementation includes setting up required devices, educating your patient on the use of the equipment, and other administrative actions.

CPT code 99453 can only be used once per episode of care, according to CMS guidelines.

For example, if you are treating a patient who recently suffered a heart attack and during the rehab and recovery process, your care team issued the patient several remote monitoring devices. The individual utilized those devices for six continuous months.

While you can use the other RPM billing codes for each monthly cycle, the billing agent for the team can only submit 99453 one time.

In a similar scenario, imagine that the patient returned all RPM equipment once the six months of remote care had concluded. The following year, the individual suffered another acute medical event that required remote patient monitoring.

In this type of scenario, your care team’s billing agent would use 99453 again to bill for the initial setup of services but could not resubmit that code further unless the patient was beginning another new episode of care.

99454

CPT code 99454 is designed to charge for the act of recording information daily.

For your care team to qualify to use this code, remote patient monitoring devices must actively record data for at least 16 days out of the 30-day billing period. Otherwise, the billing agent for the team must utilize non-RPM billing codes.

CMS considers the medical devices and the ongoing collection of patient data to be a direct expense to your practice.

10 FAQs About RPM

Here are ten common questions that patients and providers have when it comes to RPM:

1. What Are the Common RPM Management and Monitoring Codes?

As part of their efforts to expand RPM protocols, CMS has laid out a detailed order of operations for the remote patient monitoring billing process.

They have stated that the first step in RPM management is to analyze and interpret patient physiological data.

The next step is to create a custom treatment plan and implement said plan until patient improvement goals are attained. Following the plan to its goals would bring about the conclusion of an episode of care.

CPT code 99457

This code would be utilized to bill for the ongoing analysis of patient data during the remote monitoring episode of care. Code 99457 could be billed for every 30-day cycle as long as your team delivered the specified amount of care.

CPT code 99453

This code would only be billed once (at the outset of remote patient monitoring services) and cannot be resubmitted unless the provider is starting a separate episode of care.

2. What Are RPM Expense Codes?

The two primary remote patient monitoring expense codes are 99453 and 99454. CPT code 99454 is utilized for billing the costs of assessing the patient with the monitoring equipment.

CPT code 99454

Even if multiple medical devices have been issued, care team billing agents should only use 99454 once per 30-day billing cycle. The costs of operating and programming these devices for repeat monitoring should be calculated cumulatively for billing purposes.

CPT code 99453

This code is only used once per episode of care. The code is designed to address the value of your staff’s time spent educating the patient on the equipment and setting up monitoring devices.

CPT code 99457

This code is also an RPM billing code. It is used to bill for your staff’s time and analysis efforts. To use this code, the care team members must devote a minimum of 20 minutes to data review during each 30-day period.
In addition, remote monitoring must have occurred on at least 16 of the 30 days. If both criteria have not been met, then the care team’s billing agent cannot use 99457.

3. How Many Days Must Be Monitored via RPM Monthly?

Both CPT codes 99453 and 99454 have a minimum monitoring threshold that must be met. Patients and care team members must have utilized the issued remote monitoring devices to collect patient physiologic data on over half of the days in the 30-day billing period.

The rule means that monitoring must have taken place on a minimum of 16 days per cycle.

4. Which Devices Are Eligible for Medicare Purposes?

For devices to be eligible for remote patient monitoring, they must meet the FDA’s definition of a medical device. Furthermore, eligible devices must be capable of wirelessly uploading patient data.

Medicare’s remote patient monitoring guidelines do not cover devices that do not wirelessly relay data to your care team staff.

The devices prescribed to patients must also be deemed “necessary and reasonable” for the treatment, monitoring, or diagnosis of an illness or injury. Eligible devices must be utilized to reliably collect and transmit data.

This data must also assist your team in managing the care plan and understanding the patient’s status during treatment.

5. What is Considered to Be Interactive Communication?

CPT code 99457 requires your team to engage in a minimum of 20 minutes of “interactive communication” with the patient during the billing cycle. According to CMS, “interactive communication” must include two-way audio communication.

Communication can also be facilitated using other types of data sharing technology or video calling devices.

The initial 20 minutes of interactive communication should be billed using code 99457. Each additional 20-minute block of interactive communication must be reported to CMS with CPT code 99458.

Billing agents for care teams cannot utilize this supplemental code unless the criteria for 99457 have already been met during that 30-day cycle. 99458 does not serve as a standalone billing code.

6. Who Can Obtain Consent and Provide RPM Services?

Qualified healthcare professionals and clinicians can provide remote patient monitoring services provided they meet the definition described by CMS.

Your clinical staff providing care under the supervision of a licensed physician or non-physician practitioner can furnish CPT codes 99458 and 99457.

In the 2021 expansion of remote patient monitoring regulations, CMS also stated that auxiliary staff could utilize CPT codes 99454 and 99453. However, auxiliary staff personnel must also be acting under a billing physician or other licensed clinician’s “general supervision.”

CMS further clarified that health care teams should obtain consent to remote patient monitoring services when the RPM is first provided. Auxiliary staff or clinicians can obtain patient consent, provided that the correct forms are used and the patient takes a positive action to affirm consent.

7. Who Can Bill or Order RPM Care?

Since remote patient monitoring solutions are classified as evaluation and management services by CMS, they can only be ordered and billed by physicians and qualified non-physician practitioners.

These individuals must be eligible to bill for Medicare E/M services. Compliance with this provision is essential if you want to avoid any billing discrepancies or reimbursement concerns.

8. Can RPM Be Used for Both Established and New Patients?

Currently, remote patient monitoring is limited to established patients. CMS addressed this stance in 2021 and made no modifications to their existing requirements.

The purpose behind limiting RPM to established patients is to ensure that physicians have had an opportunity to conduct a physical exam and collect relevant medical history.

However, CMS temporarily waived this limitation on remote patient monitoring services in response to the national COVID-19 Public Health Emergency to allow RPM services for new patients. They have repeatedly stated that they will rescind this waiver once the PHE is over.

At that time, patient care teams will again be required to restrict remote patient monitoring services to established patients.

A notable exception to the established patient rule is the use of real-time interactive communication in the telehealth industry. CMS has not provided any specific guidance on the practice of conducting E/M services on new patients via this type of communication.

Medicare-approved telehealth providers are allowed to use new patient E/M codes. It appears that CMS is deferring to state clinical care standards on this issue.

We recommend consulting with your legal department to discuss the possibility of conducting remote E/M new patient assessments. Depending on the laws in your state, your organization may be able to satisfy CMS assessment requirements for remote patient monitoring via interactive electronic communication.

9. Is a Chronic Condition Required for RPM?

In 2019, CMS specifically limited coverage of remote patient monitoring services to patients suffering from chronic medical conditions. However, they modified this stance in response to the 2020 pandemic. Currently, CMS allows you to furnish remote patient monitoring for individuals suffering from acute conditions.

However, you must stay apprised of the latest developments in the remote patient monitoring space. Once the current Public Health Emergency is over, CMS will likely revisit this issue.

While they may allow remote patient monitoring of acute patients to continue, it is not guaranteed. CMS could provide more detailed guidelines for remote monitoring of patients with acute conditions, including limiting which ailments are eligible for this intervention.

10. What is Remote Patient Monitoring?

Remote patient monitoring is the practice of collecting, transmitting, and analyzing patient physiological data between home-based equipment and equipment located at medical care facilities. This data must be wirelessly transmitted through a secure platform to be considered remote patient monitoring by CMS.

The data collected via RPM can be used to guide your patient care protocols, monitor the progression of chronic conditions, and reduce the costs of providing medical services.

When paired with other modern care practices, remote patient monitoring can enhance your organization’s ability to serve your clients and improve your patients’ access to care.

Benefits of RPM

Through the power of remote patient monitoring, your physicians and other medical staff can gain access to real-time data on their patients. RPM software is easy to use and allows your team to efficiently care for individuals with varying medical conditions without a diminishing quality of service.

Remote patient monitoring offers a multitude of benefits to patients and your facility, including:

Enhanced Quality of Care

With RPM technology, you can immediately access patient data from anywhere. When a patient contacts your staff with a concern, flare-up of symptoms, or other issues, your care team will have the information they need to make an informed care decision. They will be able to offer expert guidance based on real-time data.

In addition, RPM will reduce the amount of stress that your providers face each day. Quality RPM coverage ensures accurate information that will equip team members to serve each patient.

Remote patient monitoring can even help reduce the risk of provider burnout, improving the patient care experience.

Easier Access to Medical Care

For patients struggling with chronic illnesses or severe acute conditions, simply making it to a doctor’s appointment is a huge undertaking. It requires patients to take time off, make arrangements with family members, and organize transportation.

Unfortunately, all of these barriers can delay care. Some patients may avoid making an appointment altogether, which can result in their health declining.

Remote patient monitoring offers easier access to medical care. Whether your patients live in rural communities, have transportation difficulties, or cannot obtain childcare, RPM provides a practical alternative.

While certain conditions and circumstances will necessitate in-person visits, RPM can reduce the frequency of these occurrences. Remote patient monitoring also makes care more affordable, which provides great appeal to many patients.

Improved Patient Engagement

With RPM equipment, your patients will be able to access their health data at any time. Increased access to this information enhances patient engagement. Your patients are more likely to get involved in their care process by developing good self-monitoring habits. Encourage them to do so by providing formal instruction and positive feedback about the benefits of RPM technology.

Be sure to point out when they make improvements. Positive feedback and good news will keep them encouraged and focused on self-monitoring, which is essential if they are battling a chronic condition or long rehab process.

Optimized Support

Home patient monitoring equipment and RPM technology will also alleviate much of the psychological stress associated with chronic illnesses. Patients and their caregivers will know that your care team is closely monitoring their health data.

Patients will also find comfort in knowing that they can reach your staff via phone or video chat instead of relying on face-to-face appointments. Keeping your patients in good spirits throughout the care process can even improve their treatment outcomes.

RPM Solutions from Med USA

Remote patient monitoring is becoming an integral part of the healthcare industry. As a result, healthcare providers, hospitals, and practices must ensure that they can offer patients these valuable services.

However, implementing an RPM program requires extensive knowledge and comprehensive planning. Otherwise, organizations risk being out of compliance with CMS billing requirements.

Med USA is here to help you to successfully offer this valuable service to your patients. If you need assistance implementing RPM solutions, contact Med USA to take advantage of our remote patient monitoring expertise and other industry services.