Based on these definitions and research we conducted as part of the development ofthe Prevounce remote monitoring software and Pylo connected patient device program, we came up with our own definition. The following is shared on our FAQs resource page: “RPM is the use of digital technologies to monitor and capture medical and other health data from patients and electronically transmit this information to healthcare providers for assessment and, when necessary, recommendations and instructions. RPM allows providers to continue tracking healthcare data for patients once they are discharged. It also encourages patients to take more control of their health.”
Though many people use the terms remote patient monitoring and telehealth interchangeably, doing so is incorrect.
To be clear, remote patient monitoring is a subset of telehealth. RPM is also not part of telemedicine, which is a different subset of telehealth.
This must be clarified because while the definition of remote patient monitoring may seem straightforward, there is some confusion about the concept, including how it differs from telehealth. Distinguishing between RPM and telehealth is important for several reasons, including coding and billing purposes.
First, let’s investigate this question: “How is remote patient monitoring different from telehealth?" A Medicaid resource states, “Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine, they are often considered under the broad umbrella of telehealth services.”
We distinguish between the terms as such:
Remote patient monitoring
“The use of a device for interaction between providers and patients outside of the provider’s organization.”
Telehealth
“The use of electronic information and telecommunications technologies to support long-distance clinical care, patient and professional health-related education, public health, and health administration.”
You can further appreciate the difference between remote patient monitoring and telehealth by briefly reviewing Medicare coding and billing guidelines. As of January 2022, there are five CPT codes covering RPM: CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 99091. None of these codes are included in the lengthy list of 2019 calendar year Medicare telehealth services codes, which cover everything from individual and group kidney disease education services, psychiatric diagnostic interview exams, advance care planning, smoking cessation services, psychoanalysis, and the annual wellness visit (AWV).
Providers delivering remote physiologic monitoring services will want to ensure they use the proper RPM CPT codes when submitting claims. (Note: If you are interested in learning more about coding and billing for RPM, download our free RPM Billing Guide).
In addition to making these distinctions, it’s also important to delineate between RPM and patient monitoring to obtain a clearer understanding.
While remote patient monitoring is sometimes confused with patient monitoring as the concepts do overlap in some regards, their difference is important. The National Cybersecurity Center of Excellence (NCCoE), part of the National Institute of Standards and Technology, does a nice job of simplifying RPM vs. patient monitoring when it states the following: “Traditionally, patient monitoring systems have been deployed in healthcare facilities, in controlled environments. Remote patient monitoring (RPM), however, is different in that monitoring equipment is deployed in the patient's home. These new capabilities, which can involve third-party platform providers utilizing video conferencing capabilities, and leveraging cloud and internet technologies coupled with RPM devices, are used to treat numerous conditions, such as patients battling chronic illness or requiring post-operative monitoring.”
Note: RPM is also different from remote therapeutic monitoring (RTM), which is a series of five treatment management service codes. Learn more about RTM here.
Now that we have defined RPM, let's gain a better understanding of the service.
Even after understanding the definition of RPM, you still may experience a bit of confusion about how RPM works. On the surface, it’s relatively straightforward, but a closer examination is necessary.
Let’s look at some common facts about the RPM process:
To deliver remote patient monitoring services, providers will need to complete other steps, including determining coverage (if considering providing RPM to non-Medicare beneficiaries), establishing a patient base, choosing a device(s), setting up a patient intake program, developing policies and procedures, and training staff. Note: By partnering with a good RPM program vendor, providers will not need to complete some of these steps and will receive assistance with others.
For patients, the ease of their receiving remote patient monitoring will primarily depend upon the design and/or complexity of the devices provided to them. Patients may require assistance (in-person or virtual) to use the technology.
Understanding what RPM is and how it works is only the first step. Providers are increasingly considering the many benefits that it will provide to their organizations.
This increased adoption comes as no surprise, considering the real benefits to the quality of care that can be delivered via remote patient monitoring. Let’s look into some of the research.
A study from the Consumer Technology Association (CTA), titled “Connected Health and Remote Patient Monitoring: Consumer and Industry Use,” provides valuable insight. Among those included in CTA's national survey were more than 2,000 adults, 100 primary care physicians, 60 endocrinologists, and 40 nurses.
The top three benefits of remote patient monitoring cited by patients were:
Healthcare professionals highlighted:
Certainly, another appealing quality of RPM is that the service is covered by a growing list of insurers and reimburses well.
On top of advantages like these, there are several other factors contributing to the upward trend of remote patient monitoring usage. Between public health concerns and challenges associated with delivering care to an aging population, RPM looks like it's here to stay. Practitioners across the country are finding this virtual service to be enticing as a safe and effective means of maintaining the delivery of healthcare to some of their most vulnerable patients.
Also driving the increase in remote patient monitoring usage is that the United States is facing a shortage of practitioners. The Association of American Medical Colleges (AAMC) is projecting a primary care practitioner shortage of as many as 55,000 practitioners by 2033. Compounding the physician shortage is that the country is expecting an overall population growth of more than 10%, with people over the age of 65 increasing by more than 45% over the same period. Since practitioner shortages are inevitable, RPM represents a smart solution to maintaining quality patient care while expanding access to care and reaching more patients efficiently and effectively.
Unfortunately, our reactive way of trying to treat chronic conditions, such as heart disease, diabetes, chronic obstructive pulmonary disease (COPD), and many others, when symptoms arise rather than managing them costs a tremendous amount of money. The United States currently spends roughly $3.5 trillion on treating chronic and mental health conditions, reports the Centers for Disease Control and Prevention (CDC). That's nearly 90% of our total annual healthcare expenditures.
The cost of healthcare is a painful pill to swallow for everyone. Consider the following about common chronic conditions that can be effectively managed by practitioners and patients by leveraging remote patient monitoring:
COPD/asthma: The current projected cost of chronic lung issues is around $50 billion annually, with the condition causing U.S. workers to miss collectively more than 16 million days of work per year.Thanks to the benefits of remote patient monitoring, practitioners and patients are finding that managing these and other chronic conditions is often much easier than they believed was possible. Beyond proactively managing the costs associated with chronic conditions, RPM offers tangible benefits to patients that are hard to deny.
Let's review five ways patients benefit from remote patient monitoring:
As noted, remote patient monitoring doesn't just deliver clinical benefits. It provides financial benefits to patients and organizations. Updates by the Centers for Medicare & Medicaid Services (CMS) to rules and reimbursement guidelines for remote patient monitoring have allowed the service to expand and grow tremendously. Officially covered by original Medicare, CMS has outlined coverage rules that Medicare Advantage plans must also follow. Most other private insurance companies follow the lead set forth by Medicare.
For Medicare patients, they should expect copays until they meet their deductible. Once the deductible is met, remote patient monitoring is covered at 80% and beneficiaries can expect to pay on average about $25 per month for each month of monitoring. While this might seem significant, consider the real cost of in-person office visits for close monitoring of chronic health conditions. Between travel time and its associated expenses as well as the wait time in a potentially infectious waiting room, $25 monthly seems like a small price to pay. Another consideration is the cost of hospital admission for unchecked exacerbations of chronic diseases, which in some cases can total in the thousands.
Meanwhile, for organizations, remote patient monitoring is one of the more lucrative Medicare care management programs. To learn more about RPM reimbursement and billing and coding for RPM, check out this blog post and this billing guide.
Health insurance companies, recognizing the growing consumer demand for and cost savings associated with telehealth, are launching “virtual-first” health plans. This insurance makes telemedicine a foundational part of the patient's care, essentially serving as a digital "front door" that allows patients to access virtual healthcare services that guide them to in-person care, when needed. If virtual-health plans are successful and achieve their objectives, the results should be more frequent, improved care access that also lowers costs, among other benefits.
Remote patient monitoring may be the most beneficial of the non-clinical remote services that health plans can consider integrating into virtual-first offerings. RPM allows patients to take vitals measurements in preparation for virtual visits and can be used as part of a care plan to show patients' progress in a more comprehensive way between visits. To learn more about virtual-first health plans and how RPM effectively fits into them, read this column. You can also learn about how the pandemic has enhanced the value of RPM for health insurers in this column.
Now that you understand some of the reasons organizations choose to offer remote physiologic management services, let’s take a look at devices most commonly used to deliver RPM services. Thanks in part to increased patient interest and an overhaul of RPM CPT codes that helped spur interest in RPM, device options are more extensive than in the past, including devices that can help meet both short- and long-term needs of patients. Knowing more about which devices are available, including those from our sister company, Pylo, can help you understand which choices not only fit your organization needs but also help maximize revenue potential.
Though there are many RPM device options on the market to learn about, we’ll discuss four of the most common ones.
It probably comes as no surprise that there’s an obesity problem in the United States. But did you know that the CDC notes that more than 42% of the American population was considered obese in 2017–2018? Complicating this issue further is that obesity-related conditions can include such serious health matters as heart disease, stroke, type 2 diabetes, and certain types of preventable cancer. Organizations can use remote weight monitoring, typically performed via a scale, for multiple purposes. For congestive heart failure patients, a sudden weight gain of even just a few pounds may be an indicator that the condition is worsening, prompting practitioners to take action, such as adjusting existing medications, prescribing a diuretic, or arranging an in-person or telehealth visit.The widespread adoption of digital health is changing how healthcare is delivered here in the United States. As such, healthcare technology companies are developing amazing new devices that can track patient vital statistics from anywhere and everywhere — powered by different forms of technology. With new device choices emerging regularly, finding the best technology for patients can be overwhelming.
When researching your options, two of the questions you will want to ask are:
Information from RPM devices can be transmitted to practitioners in one of two ways: Over a cellular network or via Bluetooth technology. But how do you determine which delivery method is the right one to choose?
When choosing the right remote patient monitoring technology, consider that there are benefits and limitations to cellular and Bluetooth technologies, so it comes down to which technology solution is the best fit for your organization, patients, and practitioners.
First, cellular remote patient monitoring devices collect and transmit patient health data over the same networks used by our cellphones. Companies that offer cellular-connected devices typically partner with major cell phone companies to access their widespread networks.
On the other hand, Bluetooth remote patient monitoring devices transmit patient data over short-range wireless connections to devices that can connect to the internet. While these technologies are typically deemed secure and reliable, there are pros and cons of each to consider.
You can use this checklist of pros and cons to help you make an informed decision.
Advantages of Cellular Remote Patient Monitoring Devices
Limitations of Cellular Remote Patient Monitoring Devices
Advantages of Bluetooth Remote Patient Monitoring Devices
Limitations of Bluetooth Remote Patient Monitoring Devices
While both types of remote patient monitoring devices — cellular and Bluetooth — offer clear advantages, we believe cellular-connected devices have an edge concerning Medicare beneficiaries. Cellular devices offer an easier-to-use, all-encompassing service if there are no connectivity barriers. The key is in the simplicity of the set up. This is crucial for two reasons. First, it reduces the need for organizations to provide ongoing technical support. Second, it is likely to decrease the chance that patients will be unsatisfied with their RPM device, which should promote continued use and cooperation.
Many organizations have found success in offering a mix of connectivity options. Bluetooth devices deliver noteworthy advantages and may be worth offering to tech-savvy patients while defaulting to cellular devices. This strategy helps you to mitigate risks on a patient-by-patient basis, but it also requires that you have a flexible remote patient monitoring platform.
However, if your organizations wants to support only one type of device, consider safety. Cellular devices can report patient vital statistics faster without needing to rely on whether patients have reliable internet access and are comfortable troubleshooting any operational issues.
No matter which technology you choose to support your devices, it’s worth examining the most common use applications for the devices as well.
When we consider the ease with which remote patient monitoring can be delivered using technology, it’s easy to see how RPM has the potential to transform the delivery of care in the United States.
To further examine the potential impact of RPM on patient care, we’ve identified nine of the top patient applications for remote patient monitoring, broken down by three of the specialties most frequently offering and prescribing RPM to their patients: cardiology, pulmonology, and endocrinology.
Within cardiology, there are four noteworthy examples of remote patient monitoring.
There are two examples of remote patient monitoring frequently offered by pulmonologists and a third example encompassing multiple conditions.
gain the ability to perform effectively and timely oversight of COPD. This leads to improvements in decision support and patient adherence to guidance and recommendations. A remote electronic respiratory monitor also allows pulmonologists to virtually support patients while avoiding potential exposure for anyone in their organization to COVID-19, particularly when patients undergo testing and measuring of their lung function. Within endocrinology, let's examine two common examples of remote patient monitoring.
For some diabetes patients, blood sugar testing is recommended periodically up to a few times a day. Such patients are increasingly receiving remote support for their diabetes management via the usage of a blood glucose meter. When patients test their blood sugar using this glucose monitoring device, endocrinologists receive the data captured and can make changes to a medication regimen and provide recommendations to improve management, if the information warrants it. Evidence shows that RPM is effective in controlling HbA1c levels in people with type 2 diabetes.With all of these proven applications, it’s evident that implementing a remote physiologic monitoring program can positively impact patient health, but how does RPM impact the financial health of an organization?
The descriptions above should help you better envision how remote patient monitoring can be incorporated into your organization to benefit your patients. However, if you still have questions about the value of RPM, it may be worthwhile to spend a little more time researching specific applications. As RPM adoption grows, so does the understanding of its numerous benefits.
For example, if you're contemplating whether to add remote patient monitoring to support those patients suffering from heart failure, you may want to read this blog post. It provides an overview of the challenge and effects of heart failure on the U.S. population before explaining how home monitoring for heart failure management can be the difference-maker patients and providers may be looking for. The column then supports this claim with examples of how RPM helps with care delivery for hypertensive patients and weight monitoring as an analogue for monitoring fluid while also explaining the cost-effectiveness of RPM, including for home monitoring of blood pressure.
As another example, if you are considering whether to leverage RPM for patients with lung diseases (e.g., asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis), read this blog post. It discusses the remote measuring and monitoring of peak expiratory flow. Among its key takeaways: The value of remote monitoring for patients with lung diseases has never been greater due, in part, to COVID-19.
Here are four things to know about remote patient monitoring reimbursement.
Remote patient monitoring is covered by Medicare. As of April 2022, it's also covered in some form by 30 state Medicaid programs, according to the Center for Connected Health Policy. The organization adds that California and Ohio only cover specific remote physiologic monitoring codes, with payment modeled after CMS reimbursement.
Numerous commercial payers cover remote patient monitoring within their telehealth coverage policies, albeit with some caveats. The number of commercial payers covering RPM experienced a surge due to the COVID-19 pandemic. While coverage of RPM was on the rise prior to COVID-19, and broader coverage for RPM was anticipated in the coming years, the health crisis accelerated this process. As the Kaiser Family Foundation notes, “… many commercial insurers have voluntarily addressed telemedicine [which includes RPM] in their response to COVID-19, focusing on reducing or eliminating cost sharing, broadening coverage of telemedicine, and expanding in-network telemedicine providers.”Here's how remote patient monitoring reimbursement breaks down using average Medicare reimbursement for 2020:
When these reimbursements are added together, the amount a single remote patient monitoring patient can earn an organization up to around $188 per month. More often than not, an organization will typically furnish about 20 minutes of RPM care management per month to a patient, which will bring the total monthly reimbursement to around $106 per Medicare beneficiary.
While $106 may not seem like a substantial amount, as a remote patient monitoring program grows, that $106 per patient quickly adds up. For example, if your organization enrolls 100 patients into your RPM program and each receives the minimum care management services, that will earn you about $127,000 in annual Medicare RPM reimbursement. Even after covering expenses associated, RPM yields significant and — importantly — consistent revenue.
Note: By providing RPM in conjunction with chronic care management (CCM) and other services, all as part of a broader comprehensive care management program, organizations will provide their patients with ongoing care that improves health and wellness while also making a more substantial impact on the bottom line. Learn more about the economics of a comprehensive care management program in this column.
Most of your remote patient monitoring services will be billed under four codes. These codes are often split into two categories: RPM “service codes” — 99453 and 99454 — and timed RPM “management codes” — 99457 and 99458.
To qualify for reimbursement, CMS expects providers to ensure they follow these remote patient monitoring requirements:
In addition, CMS stipulates that RPM devices must meet the U.S. Food and Drug Administration's definition of a medical device.
Here are four tips to help ensure you use the four primary remote patient monitoring codes properly:
In the days and weeks that followed the declaration of COVID-19 as a pandemic and national health emergency, federal and state governments as well as private payers announced changes to rules intended to help improve access to care (i.e., reduce barriers to care). This change allowed patients who were under the restrictions of stay-at-home orders to reduce contact with others and maintain social distancing while still receiving essential care services.
On the healthcare delivery side, one of the more significant changes concerned CMS temporarily relaxing and expanding telehealth rules. Remote patient monitoring is a telehealth delivery system. In May 2020, CMS issued two Medicare physician fee schedule interim final rules that revised policies and requirements.
Four of the most noteworthy changes to remote patient monitoring policies in these interim final rules are as follows:
CMS published a helpful resource answering frequently asked questions on Medicare fee-for-service billing that includes some questions about RPM. Access it here.
The 2021 Medicare physician fee schedule final rule included many significant changes to remote patient monitoring (i.e., remote physiological monitoring) and the provision of other remote services.
RPM-related topics affected by the final rule that apply in 2022 included the following:
You can read what CMS states about these topics and more here.
This remote patient monitoring CPT code requires an additional caveat. Up until the 2021 final rules, organizations could still code with the provider-specific CPT 99091 but rarely did so since the newer RPM codes discussed above were almost always the better option. The 2021 rule declared that 99091 could be billed in addition to the newer care management codes, such as CPT 99457.
However, the new interpretation issued by CMS in the final rule essentially permits providers to bill for an extra "complex" RPM management service when the provider must spend significant time managing a patient and their RPM care plan. Since the 2021 rule change, CPT 99091 can be billed each 30 days whenever complex management occurs without affecting the ability to bill clinical staff time via CPT 99457 each calendar month.
The initial 2021 final rule had quite a few confusing and contradictory statements. In reaction to this, less than two months after the final 2021 rule was issued, CMS took the unusual step to issue a correction document. This document served to clarify a number of areas of confusion concerning RPM billing requirements. These areas are as follows:
The correction document can be accessed here. A helpful summary of key takeaways is available here.
Understanding and following proper RPM coding and billing rules is essential to not only getting paid what you deserve but also to ensuring you maintain compliance with rules and regulations. RPM compliance has taken on even greater importance with the January 2021 announcement that CMS would be conducting audits of Medicare Part B telehealth services in two phases. RPM is one of the services included in the second phase.
How can providers of RPM services find themselves in auditing hot water? There are those organizations that choose to intentionally violate rules in an effort to make more money. These scenarios tend to be rare. Rather, most RPM compliance problems stem from either misunderstanding requirements, such as those described above, or engaging with RPM vendor partners that cut corners, either unintentionally or intentionally. You can learn more about the decision by CMS to begin auditing RPM and areas that will likely be focused on by auditors here.
Now that your coding and reimbursement questions have hopefully been answered, it’s necessary to examine the final consideration: How do you choose a software system that will fit your organization?
Even after arming yourself with all of the necessary information regarding what makes a strong remote patient monitoring program, you may still find yourself with one big challenge. With the RPM industry growing, organizations have an increasing number of system options to choose from. It can be hard to discern which RPM system will be the best fit, so we’ve outlined five questions that will help take the guesswork out of the process.
Before choosing a remote patient monitoring system, answer these five questions.
Specialty organizations will want to seek a system that supports RPM equipment which can collect and interpret their most pertinent patient data. Blood pressure and weight may be particularly important for cardiologists while an endocrinologist may focus on blood glucose, for example. On the other hand, general or family practices will want to base their decision of what RPM services to offer on their chosen target patient base and what conditions they want to manage.
It's not unusual to see organizations launch a remote patient monitoring program while targeting a specific condition. In other words, the organization initially manages one condition and provides only one type of RPM equipment to patients. As the organization and its staff become more comfortable with their RPM program and its associated processes, the organization begins to expand the program and provide additional services.
Some RPM vendors will provide organizations with the system and user instructions and then require organizations to perform the bulk or all of the setup work. Other vendors will take a more active role in supporting setup that can help expedite the process, better ensure questions are answered, and address any barriers to success.
Setup is only part of the equation. Once a remote patient monitoring system is set up, there is the matter of ease of use. If an RPM system proves challenging, this may deter usage by providers and staff and stifle any desire to grow a program. A more complex system may not necessarily be a hindrance if your team is tech-savvy and/or the RPM system vendor provides ongoing training and support, but you will want to determine whether these are the case before proceeding with your investment in the system.
Some remote patient monitoring systems can be customized to fit your clinical workflow, produce desired reports, and deliver notifications in the manner of your choosing. When demoing a system, work to understand ease of use, customization options, and the availability of training and support.
Another important consideration is whether and how easily the remote patient monitoring system interfaces with your existing technology, such as an electronic medical records (EMR) software and/or revenue cycle management solution. If this functionality is important to your organization, you will want to assess the ease of establishing such an interface when researching system options.
The type(s) of RPM equipment you can offer and provide to patients will vary by the system you choose. This is an especially important consideration because the success of an RPM program will largely depend upon the RPM equipment or devices used by patients.
Some vendors will require that you provide patients with the vendor's own remote patient monitoring equipment to use the RPM system. Others will allow you to "bring your own device," meaning that you have the flexibility to integrate the use of devices made by other manufacturers.
In addition, patients can receive their remote patient monitoring equipment in different ways. Some vendors will give you the option of shipping devices directly to patients (usually the vendor's own devices) while others ship devices to the organization, leaving distribution of equipment in your hands. Some RPM equipment can be purchased by patients themselves, but you will want to ensure that if patients indicate a desire to purchase their own equipment, the equipment will be compatible with your remote patient monitoring system.
Don’t forget to ask these questions: Where will support for patient setup and use of the equipment will come from? Will this be the sole responsibility of your organization or does the RPM vendor offer help, training, and ongoing support?
Lastly, consider whether you want to offer your patients cellularly connected devices, Bluetooth devices, or a combination of both, as this may impact your decision.
The type of remote patient monitoring system you use will influence whether coding and billing are consistently completed and done so accurately and how much time staff must spend billing for services. When speaking with vendors, determine how their RPM system supports coding and billing. A good RPM system will ease and streamline this process for you. Such functionality is just one of the many ways we've worked to distinguish Prevounce from other RPM systems on the market.
When you can bill accurately and efficiently, this minimizes associated staffing costs and will allow your organization to maximize what it earns after paying the RPM vendor for its service. Vendor fees will vary based on the type of program you use and may include the devices themselves, software hosting, customer support for the organization and/or patients, and cellular service.
The remote patient monitoring system you chose will help dictate the type of RPM program used by your organization and vice versa. Understanding the differences between RPM program types will help you determine what type of program you want for your organization.
A full-service program can be summarized as follows:
A self-managed program can be summarized as follows:
Making an informed decision on which remote patient monitoring system to invest in may prove the difference between whether an RPM program, which includes the software and services provided using it, successfully meets patient and organization needs or if the investment is one that an organization regrets.
Once this choice is made, it’s time to think about execution of your program.
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