Original article here https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring
The ability to monitor certain aspects of a patient’s health from their own home has become an increasingly popular telehealth option. Remote patient monitoring lets providers manage acute and chronic conditions. And it cuts down on patients’ travel costs and infection risk.
On this page:
- How to use remote patient monitoring with telehealth
- How to help patients use at-home health monitors
- Billing and payment for remote physiologic monitoring
How to use remote patient monitoring with telehealth
Remote patient monitoring pairs well with telehealth when patients need to be monitored for certain health conditions. It can also prevent health complications in patients who aren’t able to easily travel.
There are many symptoms and conditions that can be tracked through remote patient monitoring, including:
- High blood pressure
- Weight loss or gain
- Heart conditions
- Chronic obstructive pulmonary disease
- Sleep apnea
Many of the devices that patients will use may be familiar to them, including:
- Weight scales
- Pulse oximeters
- Blood glucose meters
- Blood pressure monitors
Other conditions require more complicated devices that will require patient training, including:
- Apnea monitors
- Heart monitors
- Specialized monitors for dementia and Parkinson’s disease
- Breathing apparatuses
- Fetal monitors
As the popularity and convenience of telehealth grows, so does remote patient monitoring. More providers are implementing remote patient monitoring for several reasons, including:
- Advanced medical technology
- A growing awareness of telehealth for providers and patients
- More insurance coverage during the COVID-19 public health emergency
- The ability to monitor and prevent serious complications in remote locations
A practical guide to remote patient monitoring
Learn simple, essential tips for leveraging remote patient monitoring in your practice (PDF), including applications for care management, implementing best practices, and more.
How to help patients use at-home health monitors
Remote monitoring may be new for your patients, and for you also. The best way to help your patients is to be informed about the devices you will be using. This includes how they work and how you will receive the data from the device.
Make sure patient understands why you are prescribing at-home health monitors
There are a number of ways to share information with your patients:
- A telehealth appointment before they begin using the device
- A follow-up telehealth appointment after they’ve been using the device for several days
- An email or downloadable PDF explaining remote patient monitoring for their condition or symptoms
Help your patient understand how to use their device
Some products, such as a weight scale, may not need a lot of explanation. But other devices may be more high tech or confusing for patients. Here’s a few tips:
- Walk your patient through operating the device in a telehealth appointment
- Refer your patient to an at-home medical equipment provider in their area who can set them up with the device and provide support
- Tell your patient what types of readings you will get from their device and how you will receive that information
- Make sure your patient has written instructions they can refer to, including paper copies, email, or downloadable PDF
- Encourage your patient to write down their questions and either call your office, email you the questions through a patient portal, or request a follow-up telehealth appointment
- Have a member of your staff let your patient know when you are receiving their information correctly from the device
Talk to your patients about the benefits of remote patient monitoring
Some patients will need in-person testing, diagnostics, or monitoring. This depends on their condition, Internet capabilities, or personal preferences and abilities. But there are many ways that remote patient monitoring can help with chronic conditions, pregnancy complications, and short-term illness.
These benefits include:
- Reduced hospitalizations
- Shorter hospital stays if the patient can be discharged with a remote monitoring device to use at home
- Fewer visits to the emergency room
- Better health outcomes for patients in rural areas
- Better preventative management for chronic conditions
- Reduced risk of COVID-19 exposure, along with other illnesses, for patients and health care workers
Tip: Medicare uses the term, “remote physiologic monitoring” in their coding and billing language. Remote physiologic monitoring (RPM) is a set of codes that describes non-face-to-face monitoring and analysis of physiologic factors used to understand a patient’s health status. For example, the RPM codes allow remote monitoring of oxygen saturation levels in patients with COVID-19. CPT codes 99453, 99454, 99457, and 99458
Billing and payment for remote physiologic monitoring
Billing for Medicare
While private insurance companies set their own terms, Medicare has its own payment policies.
- An established patient-physician relationship is required. But there does not have to be an established relationship between the patient and physician for the duration of the public health emergency
- Consent to receive remote physiologic monitoring services at the time services are furnished is allowed
- Physicians and non-physician practitioners who are eligible to furnish evaluation and management services (E/M) may bill for remote physiologic monitoring services
Update on the COVID-19 Public Health Emergency
The Administration’s plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023.
Guidelines for remote physiologic monitoring services billed to CPT codes 99453 and 99454
- Physiologic data must be electronically collected and automatically uploaded to the secure location where the data can available for analysis and interpretation by the billing practitioner
- The device used to collect and transmit the data must meet the definition of a medical device as defined by the FDA
- Remote physiologic monitoring data must be collected for at least 16 days out of 30 days. During the public health emergency for COVID-19, if a patient is suspected or diagnosed with COVID-19, data can be collected over as few as two days
- Remote physiologic monitoring services must monitor an acute care or chronic condition
- The services may be provided by auxiliary personnel under the general supervision of the billing practitioner
- The Centers for Medicare & Medicaid Services (CMS) recently published policy updates for Medicare telehealth services in the 2023 Physician Fee Schedule. Under Medicare Clinician Services, CMS will not implement new codes for remote therapeutic monitoring (RTM) as initially proposed.
For specific codes and requirements for Medicare’s remote physiologic monitoring coverage, visit the 2023 Medicare Physician Fee Schedule page from the Centers for Medicare & Medicaid Services.
Billing for private insurance
Check with the patient’s insurance company for information on their billing and reimbursement policies.
Billing for Medicaid
Each state has its own remote patient monitoring billing and reimbursement policies. Providers can check their state’s policies at the National Policy Center – Center for Connected Health Policy .
The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic — Agency for Healthcare Research and Quality
Enforcement Policy for Non-Invasive Remote Monitoring Devices Used to Support Patient Monitoring During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PDF) — U.S. Food and Drug Administration
Telehealth in Rural Communities — Centers for Disease Control and Prevention (CDC)