Care Groups

Medical practices and health systems are looking to embrace remote patient monitoring as a way to provide convenient care delivery. Recent policy changes by The Centers for Medicare and Medicaid Services have expanded coverage for the platform making it easier for patients to get the care they need while providing a big revenue opportunity for your practice.

What is remote patient monitoring?

Remote patient monitoring allows providers to use connected electronic devices to manage certain aspects of their patient's health while cutting down on patients' travel costs and risk of infection. Remote patient monitoring can be used to provide care for both acute and chronic conditions and has become an increasingly popular care option.

Historically, services that are paid under the Medicare physician fee schedule had to be provided in person and the physician had to be in the room in order to be able to bill them.

Starting in 2019, CMS started to recognize that there was a benefit to allowing physicians to remotely collect and analyze patient data in order to provide quality care. CMS decided to change its policy to allow payment for remote evaluation or virtual check-ins with their doctor. These virtual visits are not considered to be a telehealth service making them exempt from previous Medicare payment restrictions.

Most remote patient monitoring services will be billed under four CPT codes. These codes are frequently split into two categories: RPM service codes and timed RPM management codes

The four primary CPT codes for remote patient monitoring are:

• CPT 99453 – Initial device setup and patient education
• CPT 99454 – Remote monitoring of patient data, every 30 days
• CPT 99457 – RPM requiring interactive communication - first 20 minutes
• CPT 99458 – RPM requiring interactive communication - each additional 20 minutes

Over the past four years the payment rates have dropped slightly for some of these services, but there's still a significant revenue opportunity if these are the kinds of services that your practice provides.

What are the requirements for remote patient monitoring?

Before you start billing for remote patient monitoring, here's a few things to remember.

1. Patient care must involve work separate from an office visit and should not be billed with E/M code(s).
2. The device used for remote monitoring must be a medical device approved by the FDA
3. Service must be ordered by a physician or other qualified healthcare professional
4. Always code to the highest level of specificity
5. Remote evaluations can be reported during the same service period as other care management codes, but you cannot report the same time for multiple codes
6. These visits require live interactive communication
7. Only report code 99457 once per month, use code 99458 for each additional 20 minutes
8. Do not report code 99457 for less than 20 minutes of service

Benefits of remote patient monitoring

A 2019 study from the Consumer Technology Association surveyed healthcare professionals and patients to determine the perceived benefits of remote patient monitoring. The healthcare professionals surveyed said the biggest benefits of using connected to technology to manage health are improved patient outcomes (49%), improved compliance rates (44%) and patients taking more responsibility for their health.

For patients who participated in the study, the top three benefits are detailed information to personal health information (43%), faster access to healthcare services (42%) and more influence on their own well-being due to feeling a sense of ownership of their health data (37%).

More than half of the patients surveyed also indicated that they would use a remote monitoring device as part of their treatment if a doctor suggested it.

What are remote patient monitoring devices?

There are four common remote patient monitoring devices that practices should consider before starting a RPM program.

• Blood pressure monitor - Providers can keep track of blood pressure using cuffs on patient's wrists to improve hypertension management. The American Heart Association says research has shown that remote cardiac monitoring can drastically reduce patient blood pressure compared to self-monitoring.
• Weight monitor - Practices can use connected scales to monitor weight for patients who may be at risk for congestive heart failure. For patients working to lose weight, ongoing monitoring can help illustrate trends and measure success.
• Blood glucose monitor - Watching blood glucose levels is important to keep patients with diabetes safe. Glucose monitoring can be performed using various remote patient monitoring devices, including some that do not require patients to draw blood.
• Spirometer - Remote spirometry lets providers monitor a patient's lung condition to determine whether treatments like medication can be successful in helping to manage breathing issues. The COVID-19 pandemic greatly contributed to the increase in remote lung function monitoring for patients with respiratory risks.

Is remote patient monitoring worth it?

Changes by CMS to rules and reimbursement guidelines have allowed remote patient monitoring to expand and grow in popularity. As of April 2022, 30 states have some form of Medicaid reimbursement for remote patient monitoring in their Medicaid programs.

By providing 20 minutes of remote patient monitoring per month, each Medicare beneficiary can add roughly $1,400 in revenue to your practice over a 12-month period. At that rate, if you have 100 patients enrolled in a remote patient monitoring program your practice can expect to generate a little over $10,500 a month in revenue for care you may already be providing.

This example does not include reimbursement you may receive for initial training or for any additional billable time beyond the initial 20 minutes. Just remember, remote monitoring services must meet all coverage requirements and be reasonable and necessary in order to be reimbursed.

Following the proper remote patient monitoring coding and billing rules laid out by CMS is not only crucial to get paid what you deserve but also to ensure you maintain compliance in the event you are audited.

The Future of Remote Patient Monitoring 

Healthcare technology has become more critical in recent years, particularly as the COVID-19 pandemic has made it necessary to implement new care strategies for everyone’s safety and well-being. Virtual options, including telehealth and remote monitoring, are growing trends in innovative primary care.

Just as the most useful and effective electronic health record (EHR) systems are scalable, so are remote patient monitoring solutions. The EHR developer who focuses on the connectivity and interoperability of each of these healthcare tools will be able to offer the quality technology that independent primary care practices need in today’s digital world.

Remote patient monitoring has been shown as helpful in managing chronic conditions, engaging rural patients, and providing personalized and equitable healthcare across the provider’s patient panel. The ability to collect measurements such as blood pressure, heart rate, and activity levels can mean the difference in patient outcomes. Providers can monitor patient data between visits or in preparation for telehealth visits.

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Many third-party payers, including Medicare, are recognizing the value of remote patient monitoring. Medicare reimburses RPM services just like in-person clinical services with no additional requirements. Improvements in the technology and pandemic-related shifts in care delivery modes have enabled patients to get the quality care they need from the comfort and safety of their own homes.

Remote patient monitoring enables the provider to gather, record, and monitor crucial patient health data. The physician can analyze the data for assessment and decision making, virtually and in real time. The use of remote patient monitoring tools has been shown to improve the patient’s quality of life as it is a cost-effective approach that reduces the potential for hospitalization. The technology also increases the provider’s efficiency and effectiveness.

Examples of remote health monitoring devices include:

• Continuous glucose monitors that remind patients with diabetes to take their insulin while the physician is also able to monitor the disease in the patient
• Digital blood pressure monitors that send data to the provider
• Blood oxygen level monitors that send the patient’s information to their primary care physician.

Though remote patient monitoring technology is useful for patients in remote or rural areas, it can also be quite beneficial for patients who need consistent monitoring or who may not need multiple in-person visits other than to have their vitals checked regularly. Remote patient monitoring systems can prevent more severe and costly health outcomes as the provider is continually receiving the pertinent information regarding the patient’s current condition.

In particular, elderly patients can benefit from the remote patient monitoring technology as that patient population tends to have a higher incidence of multiple chronic diseases. A KLAS Research report found that 38% of healthcare organizations running remote patient monitoring programs focused on chronic care management reported reduced hospital admissions, while 17% cited cost reductions.

For the EHR developer that builds out interoperable medical records systems, the use of remote monitoring and artificial intelligence will become a critical trend in reducing healthcare errors and in reducing the gap between provider and patient, improving patient outcomes and the patient-provider relationship.