Remote patient monitoring: Building a new outpatient revenue stream

Remote patient monitoring (RPM) is more than just fancy activity trackers. It is a way to reduce hospital admissions, lower healthcare costs and provide better care and outcomes for patients. With RPM, physicians can leverage data to help give patients better feedback regarding their conditions and treatment. In addition, RPM can also be a way to increase revenue for outpatient practices.

In simple terms, RPM is a device that collects patient data and transmits it via the internet to a physician. The collected data allows a physician to monitor changes in patient vital signs and act accordingly. There are many different types of devices on the market, which all monitor different vital signs.

For example, a patient who is on non-invasive ventilation would be very sick with chronic disease — so sick that they would need to be on a home ventilator. It is easy to see why physician and patient both would want to have a monitoring system for this situation. The RPM device would monitor activity, respirations and heartrate. Each day, the physician’s staff would review the patient’s vital signs and have preset thresholds. If the vitals were outside normal thresholds, the physician would be notified and he or she could talk to the patient and act accordingly. This allows the healthcare team to be proactive.

RPM can be used for patients with chronic disease such as COPD, congestive heart failure (CHF), diabetes and those who frequently visit the ER. However, RPM is not a replacement for emergency medical services. Monitoring is not done in real time and patients will still have to call 911 for emergencies.

Components of an RPM program

Most medical practices work with a vendor to supply devices and the monitoring platform. The Centers for Medicare & Medicaid Services (CMS) now allows these services to be outsourced completely, so practices can decide between setting patients up and providing monitoring or outsourcing all services, including:

• Device
• Monitoring platform
• Staff time to initiate patients
• Staff time to perform patient setup
• Staff time for billing

Checklist for choosing a vendor

• How long have they been doing this?
• How many patients do they have on RPM?
• What do you want to measure?
• Do they offer devices and monitoring?
• Are there warranties on devices?
• Are they HIPAA compliant?
• Do they offer help with patient device issues and offer customer service?
• Does the platform allow for tracking time spent monitoring?
• Can you run a report on patients who have 20 or more minutes tracked that can be billed?
• Does the platform interface with your practice management system or do you have to manually enter charges each month?
• Are the terms of the agreement specified?
• Do they provide reference checks for other clients?

Starting RPM in a medical practice

Once a vendor has been selected, it is time to work on implementation. Below are tips for how to make sure the RPM program is successful.

1. Do a pilot — Start with one provider who will be the “champion” and commit to working the kinks out for the rest of the practice.

2. Nonphysician provider buy-in — This will not be a huge time commitment for medical assistants (MAs) and nurses, but it can also be something they forget to do on a daily basis. Make sure there’s buy-in, they understand the process and that there is someone reviewing the metrics.

3. Initial setup — It may be slow at first until staff and providers know what they are doing. Create detailed instructions for patients.

4. Patient education — Be prepared to educate your patients about the program and have answers ready when questions rise.
   • Have patient phone calls routed to a knowledgeable point person to avoid patient and staff frustration.
   • Make sure patients with issues know not to call physicians at night.
   • Prepare a FAQ on a handout and post on practice website. 

5. Billing and coding — Make sure your billing team is up to speed before getting started and that you have a plan in place for capturing charges.

Billing and coding

Capturing the charges for the RPM services is equally important.  Since the monitoring codes are only billed once a month, you must have a way to track which patients have met the 20 minutes each month.  The initial set-up and device codes can be billed on the day that the patient is in the office and gets set up on the device. Any providers or coding staff in your practice should familiarize themselves with these frequently used codes for billing RPM services:

• 99453 — Initial set-up: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
•  99454 — Device: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
• 99457 — 20 minutes of monitoring per month: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
•  99458 — Additional 20 minutes per month: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

Requirements for 99457:

• Patient must opt-in for the service
• Device must meet the FDA’s definition of medical device
• Device must be supplied for at least 16 days to be applied to a billing period
• Service must be ordered by a physician or other qualified healthcare professional
• Data must be wirelessly synced where it can be evaluated
• Data-monitoring services may be performed by the physician, by a qualified healthcare professional or by clinical staff. Clinical staff may include RNs and medical assistants, depending on state law.

Keeping closer tabs on high-risk, high-cost patients is now available with RPM. It’s a way to reduce overall healthcare costs and increase revenue for outpatient practices. RPM also doesn’t require a tremendous amount of work for physicians, yet it provides patients and family members peace of mind that someone is “monitoring” the status of their chronic disease.

Additional resources

• "Telehealth billing during the COVID-19 national emergency"