REMOTE

Patient Monitoring Guide

4G

www.prevounce.com
 RPM delivers tangible improvements in health and quality of care for patients and a
large volume of eligible patients for practices.

What is RPM? 3

RPM Patient Applications 4

Benefits of RPM 5

Return on Investment 6

Billing Requirements for RPM 7

RPM FAQ 9

www.prevounce.com 2
 What is RPM?

RPM is the use of digital technologies to monitor and capture medical information from patients and
electronically transmit this information to healthcare providers for assessment. 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.

08:00
Glucose
SYS
118
DIA
78
mmHg

89
mg/dl
PULSE
/min 78
START./STOP

RPM is a CMS program that requires patient consent for enrollment. It involves the collection and analysis
of patient physiologic data that is used to manage a patients chronic/acute condition. The four primary
Medicare RPM codes are CPT codes 99453, 99454, 99457, and 99458

www.prevounce.com 3
 RPM Patient Applications

Hypertension management

Millions of U.S. adults have high blood pressure, yet most do not have it under control. Since
hypertension usually presents without symptoms, the only way to determine whether a patient has high
blood pressure is to measure their blood pressure. With ongoing remote monitoring of hypertension,
cardiologists can make timely recommendations that better support heart-healthy living, such as
changes to diet, exercise, and medication regimen. Research cited by the American Heart Association
notes that remote cardiac monitoring can greatly reduce patient blood pressure compared to typical care
and self-monitoring alone.

Medication management
and titration

Treatment of high blood pressure is typically a lifelong process and one that often requires one or more
prescriptions. Throughout treatment, a patient’s medication regimen is likely to undergo regular - and
sometimes significant - changes to help achieve blood pressure goals. Remote patient monitoring can
better ensure cardiologists are receiving the accurate data on hypertension they need to make
appropriate adjustments to a regimen. In addition, performing medication management via RPM elimi-
nates the need for patients at increased risk of severe illness from COVID-19 to make multiple, in-person
visits to your practice.

Weight measurement for

congestive heart failure

A sudden or steady gain in daily weight (e.g., 2 to 3 pounds in 24 hours or 5 pounds over a couple of
weeks) can indicate that the body is retaining fluid - a symptom of heart failure. In fact, patients can gain
up to 10 pounds of “extra” weight from fluid before feeling bad or experiencing swelling. With remote
patient monitoring, cardiologists are alerted of such cardiac decompensation, allowing a fast response
that can help reduce the condition and likelihood of hospitalization or critical care. Daily weight
monitoring is frequently cited as one of the cornerstones for effective CHF management.

Weight measurement
for obesity

Our country’s obesity problem gets a lot of attention, but it may be even worse than you realize. More
than 42% of the American population was considered obese in 2017-2018 -a figure that is up from
about 31% in 1999–2000. At the same time, the link between obesity and cardiovascular disease has
never been clearer. In response, many cardiology practices now include weight management in their
patient’s care plan to lower cholesterol, hypertension, and the risk of a cardiac event. Ongoing
monitoring of a patient’s obesity can help ensure lifestyle changes intended to stabilize or reduce weight
are proving successful and assess whether more aggressive measures, such as prescribing weight-loss
medications or performing surgical procedures, are warranted.

www.prevounce.com 4
 Benefits of RPM

Patient Benefits
The use of RPM has skyrocketed in the last two years with healthcare organizations and major insurance
payers (including Medicare) recognizing the patient health benefits of a well implemented RPM program.
Patient benefits include:

Better access to the healthcare team.

Since RPM devices report real-time health data, practitioners are kept in the loop
on their patients’ current health status, providing patients and caregivers with
more peace of mind.

Fewer trips to the practitioner’s office.

This means less exposure for patients to other illnesses and fewer expenditures in
both time and money for travel.

Improved quality of care.

With RPM, practitioners gain a more holistic understanding of a patient’s health
condition, which can lead to more accurate adjustments in medications, fewer
emergency room visits, and more time between in-office visits.

Better support and education.

Since the healthcare team receives more detailed information about a patient’s health
status, practitioners can provide better individual support and education. This back and
forth improves patient buy-in and adherence to their care plan which results in better
patient outcomes.

Financial Benefits
RPM has become a significant source of revenue for physician practices and groups. Financial and revenue
benefits include:

Significant clinical revenue.

$ Medicare reimburses up to $210 per patient per month for remote patient monitoring
services. Including the training code, RPM can earn around $2,500 per RPM patient
per year. We recently performed a case study on a single provider cardiologist office
and found they were able to leverage their Medicare patient population to earn around
$35,000 extra practice income per month after implementing RPM.

Get reimbursed for interactions you already do.

Remote patient monitoring allows offices to be paid for care coordination time spent
by clinical staff which they are often already doing. If you have patients watching vital
measurements or medication plan at home, almost all the time spent communicating
with that patient can be counted as RPM time once they are enrolled in a program.

www.prevounce.com 5
 Remote Monitoring Revenue Estimate

RETURN ON INVESTMENT VIA MEDICARE

Medicare (including Medicare Advantage plans) has one of the most robust RPM coverage and reimbursement
schemes. The table below shows the average reimbursement by patient enrolled in the program as well as
how much clinical staff time is generally spent per patient on average.

Patient Average RPM Total Monthly

Quantity Reimbursement Reimbursement

50 $140 $7,000

150 $140 $21,000

250 $140 $35,000

500 $140 $70,000

COST AVOIDANCE METRICS

Reimbursement via pay-per-service insurance is often supplemented by a reduction in costs brought on by

the benefits of RPM. Depending on organization type, a well-tailored RPM program can decrease costs in the
following areas:

Hospital readmission reduction

Under 30 day hospital readmissions
Emergency department utilization decrease
Reduction in in-home skilled nurse visits

OTHER SERVICE LINES

Medicare currently allows some traditionally in-person services to be performed remotely when a patient is
enrolled in remote patient monitoring. These include hospice and home health care planning services and
virtual cardiac rehabilitation.

www.prevounce.com 6
 Billing Requirements for RPM

Billing for Remote Patient Monitoring

The vast majority of RPM services will be billed under four CPT codes. Generally, these codes can be split up
into two categories: RPM “service codes” and timed RPM “management codes.”

RPM Service Codes: 99453 and 99454

RPM service codes reimburse for the expense associated with furnishing RPM services, including the cost
associated with the device, the initial education and training of the patient, and the transmission of the data to
the practice. These codes include:

Remote monitoring of physiologic parameter(s) (eg, weight, blood

CPT Code 99453 pressure, pulse oximetry, respiratory flow rate), initial; set-up and
patient education on use of equipment. (2020 average pay rate: ~$21)

Remote monitoring of physiologic parameter(s) (eg, weight, blood

pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply
CPT Code 99454
with daily recording(s) or programmed alert(s) transmission, each 30
days (2020 average pay rate: ~$64)

CPT 99453 is used to report the setup and patient education on RPM and use of the device(s). As such, this
code is generally billed once per patient on the initiation of RPM services.

CPT 99454 is the monthly code that reimburses for the supply of the device and monitoring of patient data.
This code requires that patient readings be performed at least 16 days each month.

RPM Management Codes: 99457 and 99458

RPM management codes are monthly time-based codes covering interactive communication with the patient
(or caregiver) to manage treatment or the care plan or interpreting and acting on transmitted data. They
include:

Remote physiologic monitoring treatment management services, clinical

staff/physician/other qualified health care professional time in a calendar
CPT Code 99457 month requiring interactive communication with the patient/caregiver
during the month; initial 20 minutes. (2020 average pay rate: ~$55)

Remote physiologic monitoring treatment management services, clinical

CPT Code 99458 staff/physician/other qualified health care professional time in a calendar
month requiring interactive communication with the patient/caregiver
during the month; additional 20 minutes. (2020 average pay rate: ~$44)

www.prevounce.com 7
As such, for the first 20 minutes of logged management time each month a practice can bill 99457. Once
99457 has been billed, a practice can add up to two instances of 99458 at 40 minutes and 60 minutes,
respectively.

As of 2020, CMS has announced that 99457 and 99458 can be furnished by clinical staff under the general
supervision of the billing provider.

Billing RPM in Action

Putting all four of the above RPM codes into action, the billing for RPM looks something like this:

RPM Billing

First Month Monthly

Initial Enrollment Base Monthly RPM Care Management Care Management Care Management
(20 min) (40 min) (60 min)

99453: Initial patient 99454: Remote 99457: 20 minutes of 99458: Additional 20 99458: Additional 20
setup and enrollment monitoring and clinical staff time minutes of clinical staff minutes of clinical staff
into RPM program. management of device communicating with communication with communication with
readings. patient or caregiver. patient or caregiver. patient or caregiver.
Averages $64. Averages $55. Averages $44. Averages $44.

20 min +20 min +20 min

$21 $64 $119 $163 $207

You bill 99453 when you first initiate RPM services on a patient. Then you bill 99454 for each month the
patient transmits readings at least 16 days.

In addition to the monthly 99454, you also bill for the amount of time you spend managing the patient
within the program. The first 20 minutes of such management is billed under 99457. You can then bill
99458 for each additional 20 minutes, up to a total of 60 minutes of management time.

Non-Medicare Coverage

Since CMS adopted RPM, other insurance providers have also begun to reimburse for the service. As of this
writing, more than 20 state Medicaid programs and many private insurers reimburse for RPM, although some
have different requirements compared to Medicare. The Center for Connected Health Policy curates two
reports that detail state-by-state telehealth coverage; one focusing on Medicaid policies and one on
commercial policy regulation.

www.prevounce.com 8
 RPM FAQ

As RPM is in a state of expansion and change, we decided to link to our up-to-date FAQ on our website
instead of publishing it here. You can find our curated RPM frequently asked questions here. If you don’t see a
question there that you would like answered, or want clarification on something in this guide, be sure to reach
out to us at info@prevounce.com or via phone/text at (818) 600-7160.

Interested in learning more? We offer free 20 minute consultations with one of our RPM experts where we can
answer any questions or help plan the implementation of RPM in your office.

To learn more, schedule a

demo today.

Schedule a Live Demo!

How to Find Us
Call or visit us online to find out how RPM can positively impact your practice.
www.prevounce.com | 800-618-7738
9