Coordinating an effective remote patient monitoring (RPM) program that is both engaging for patients and lucrative for a practice can be challenging for even the most harmonized teams and amenable patients. Understanding all the rules, regulations, and components that surround RPM is essential for creating a program that flows well for your practice and keeps patients engaged in and compliant with best practice treatment protocols. To help your team create the most efficient and effective RPM program possible, we've highlighted a few key details that should make the process easier.
The Bigger RPM Billing Picture
Each step of the RPM process comes with tasks that correspond to billing codes for reimbursement purposes. To ensure nothing is overlooked, it's important to understand what must be completed by the practitioner and the patient to receive proper reimbursement. Making sure your practice is savvy with current coding and billing rules will allow your team to work towards building a more engaging program for your patients while maintaining RPM compliance, and receiving appropriate, maximum reimbursements for your efforts.
Start at the Beginning: CPT 99453
While patients are not typically interested in understanding the RPM coding and billing process, they will still appreciate an organized, well-setup care delivery system with processes that are easy for them to follow. You can establish this expectation right off the bat. When providing patients with their new RPM technology, use this opportunity for your care team to walk them through the concept of remote patient monitoring, using the technology, and what they should expect from their RPM experience going forward.
While patient enrollment into RPM can be done in person or virtually as long as consent is received, many patients and practices find that discussion of RPM for condition management is often a natural transition during a routine office visit. The practice can prove to be the ideal environment (especially for older patients/non-digital natives/etc) for enrollment as it provides a great chance to give hands on help to the patients in becoming more comfortable with using the technology. Having this conversation in person not only allows the patient to ask any questions they may have to their care team directly, but it also gives the provider and/or care manager(s) to outline important program expectations that the patient will be expected to meet while enrolled. (Some practices may find it beneficial for increasing patient compliance with program expectations by outlining them in the patient consent for enrollment form they cover with the patient). Possible program expectations for patients include:
- Number and type of measurements to be recorded
- Frequency measurements will be recorded and sent to the healthcare team
- Determining patient goals and a timeline to achieve those goals
- Program expectations around monthly communication between the patient and their care management team
Upon completion of this part of the RPM process, the patient should feel comfortable with their device(s) and their participation in the program. They should have learned how to set up their device, operate it properly, and have a basic idea of how to troubleshoot or who to contact if they have questions or concerns.
Moving the Data: CPT 99454
Once your patient has received and set up their RPM device, it's time to start using the technology. At this point, outcomes are largely dependent upon patient adherence to obtaining regular readings and meeting the goals set forth by their care team. These outcomes should be recorded and transmitted as documented during the setup process.
CPT 99454 allows your practice to be compensated monthly while you are actively monitoring the patient's health status using a remote patient monitoring device. For reimbursement purposes, there should generally* be at least 16 clinically relevant readings every 30 days (*See "How many days must RPM services be delivered to be billable during the pandemic?" here). Keeping the patient engaged consistently with the program is vital to positive health outcomes and reimbursement.
To make the process easier, some platforms like Prevounce make engaging the patient easier with customizable notifications. The need to remind patients that they need to collect their health information with their device to adhere to their care plan is highly likely, and reminder technology can make this process even easier for the care team and patients.
Care Management and Clinical Consultations: CPT 99457 & 99458
Effective remote patient monitoring engagement requires keeping up with regular care management and clinical consultations. At a very minimum, the care team should spend at least 20 minutes engaging with the patient monthly. It's important that patients not only adhere to communication guidelines and goals set forth by their care team but also that they are willing to interact with their healthcare team on a regular basis.
What's great about CPT 99457 is that it allows for these visits and consultations to be performed virtually, keeping the entire process convenient for the patient and efficient for the practice (and also safer during this public health emergency). CPT 99457 allows your team to bill for the first 20 minutes per month of care management and clinical consultation time with the patient. With CPT 99458, you can bill additional time, in 20-minute increments, above and beyond the first 20 minutes.
Care Management Expectations for Successful Remote Patient Monitoring
While engaging the patient is one of the most significant facets of executing a successful RPM program, it's nearly impossible to achieve full engagement if the healthcare team doesn't completely understand the RPM process and program expectations themselves. The clinical team should have a clear understanding of what is required to properly fulfill all requirements of each CPT code. After the initial device is set up, measurements and the number of minutes spent on patient care must be followed as ordered by the practitioner, with a minimum of 20 minutes of patient-related care/tasks documented per month. Most Medicare regions limit the maximum amount of time spent to 60 minutes.
To effectively engage patients, care management teams should schedule internal reminders for clinical staff to check in with the patients at regular intervals and set up notifications through their RPM vendor to remind patients to take their measurements and to reach out if they are experiencing issues or concerns. Regular check-ins with the patient to discuss the incoming data and ensure the device is working properly all count toward the care management CPT codes. The care team should also have notifications set up through the RPM platform to immediately alert the care staff and patient when readings are out of normal, healthy ranges.
Patient Expectations for Successful Remote Patient Monitoring
Expectations for patients are much broader. First and foremost, they will need to consent to enrollment into a remote patient monitoring program. When they consent to participation, consider discussing or reiterating the importance of them being fully engaged and active participants in their care. Next, patients should clearly understand that the program is not a substitute for emergency services, and if their condition becomes dangerous, they should still seek out emergency care.
Providing the patient with a clear definition of remote patient monitoring, what they should expect during their participation in the program, and what is expected at the completion of their RPM participation period (if applicable) will help set you and your patients up for a more successful and clinically meaningful experience. The patient should understand and expect that the care team will be actively and regularly communicating with them.
Lastly, make sure patients know how to contact their care managers when needed. For successful engagement, patients should be able to connect with the care managers directly about everything from questions regarding their device or remote patient monitoring in general to the specific health conditions being tracked. The idea is to provide a convenient, direct connection with the care team, allowing patients to skip the phone tag process that often occurs when calling a practitioner's office.
Make RPM Worthwhile for Patients and Your Practice
Patients will often be excited about participating in an RPM program in the beginning, but that excitement might start to dip as time goes on. While virtual services that use remote technology are convenient, they could start to feel redundant or even a little invasive to some patients. To combat these issues, it's important to incentivize patient adherence with their RPM program. The service should be worthwhile to the patient outside of the scope of just having readings sent to their care team. Patients tend to be more engaged and invested in building the relationship with their clinicians when their care team is proactively asking about their personal concerns and actively supporting patient goals. Aside from the required documentation for billing, ensuring the patient's journey is documented, personalized to suit their specific needs, and the smallest of wins are celebrated will go a long way in encouraging continued and enthusiastic participation.
Work to keep the engagement and adherence process as easy as possible for your patients.
Remote patient monitoring is no small task to undertake for any healthcare team. Putting together the RPM puzzle might look a little different for every practice but taking the time to do it right, including selecting the right system, can go a long way in successfully serving patients with chronic diseases. While the process can require some changes within existing workflows and practices, adding remote patient monitoring will be great for your patients and fruitful for your bottom line.