When using RPM, providers see improvements in

• patient-provider collaboration;
• patient outcomes;
• chronic condition management;
• revenue streams;
• access to patient data trends.

RPM also helps decrease hospital stays, hospital readmission rates, emergency visits and disease transmission rates. RPM also helps reduce burden on health care systems, because RPM nurses support patients at home, and patients become more acquainted with forms of digital health monitoring and telehealth services.

Patients who participate in RPM experience

• increased engagement in their health and health care;
• improved access to health information, especially through the RPM nurse, who helps identify any issues early and allows for earlier interventions;
• enhanced knowledge and understanding about their health and their diseases or conditions;
• improved adherence to care plans;
• improved quality of life.

The American Medical Association (AMA) has compiled the Digital Health Implementation Playbook (2018) to walk providers through the implementation process of a full remote monitoring program. The key steps and considerations from this resource and others are summarized here:

1. Identify a provider champion.
2. Identify funding sources for equipment, monitoring software, performance of remote monitoring and care management team.
3. Identify the patients who would benefit from at-home monitoring. Use a needs assessment and develop an implementation team based on the assessment results. Successful programs often start with a small group and plan for expansion. Evaluate what tools and resources are needed to support the program. RPM is often set up through a chronic care management program or a population health program.
4. Assess federal, state, local and payer telehealth and telemonitoring regulations. (See Resources for more information.)
5. Select device vendor/data input application and monitoring software. Practices often partner with a vendor to provide a package for software, connected devices and clinical monitoring services. Determine whether the software can/should integrate into your electronic health record system or should be a standalone platform. (See Resources for more information or view our Partners webpage.)
6. Develop monitoring parameters, protocols and workflows with appropriate medical director oversight. Determine whether monitoring will be done in-house or via collaboration with a third party. Consider developing patient education materials. Clinical monitoring can provide proactive care, monitoring and alert management, education and coaching, analysis and reporting and coordination and collaboration.
7. Develop patient screening, enrollment and onboarding processes with the involvement of a patient advisor. Include a patient consent form for RPM. You may also want to have participating patients sign a release of information for the caregiver.
8. Use remote monitoring data to improve individual and population health in your community. Data analysis can be done through your office, a software vendor or through a clinical call center such as the services Mountain-Pacific Quality Health provides via Connect America.
9. Integrate data into your quality improvement and clinical outcomes monitoring process.

Billing/RPM Codes

Medicare covers RPM services, but it is billed under Medicare Part B as an outpatient service and is subject to the 20-percent copay. Medicaid coverage varies by state. Contact your local Medicaid office to verify coverage. Commercial payer coverage also varies, and prior authorization is recommended before starting RPM.

Billable RPM codes are:

• Code 99453 – Initial set up (one-time billing code)
• Code 99454 – Device supply and daily recording (16/30 days monitoring per 30 calendar days) (monthly billable code)
• Code 99457 – 20 to 39 minutes of clinical review or care management per calendar month (monthly billable code)
• Code 99458 – For an additional 40 minutes, bill code 99457 plus bill code 99458
• Code 99091 – 30 minutes of provider time per month

Billing reimbursement differs by location. Check the Centers for Medicare & Medicaid Services (CMS) fee schedule for reimbursement amounts.