What type of patient qualifies for remote patient monitoring?

Patients who have one diagnosis that would be better supported with monitoring and care management.

Patients that are acute or chronic qualify

What are the top disease states that are seen in RPM?

RPM can be used for any acute or chronic diagnosis, but the top disease states are as follows: Diabetes, CHF, COPD, Kidney disease, Covid, Hypertension or any other heart disease other wise specified.

Some of the acute conditions are as follows: Covid, S/P surgery, Pneumonia, Cancer, and chemotherapy monitoring etc.

How do my patients get offered the RPM program and get enrolled?

Our Care Management partners provide screening and enrollment services for RPM. Provider offices are provided RPM literature for discussing with the patient if indicated. Patients are contacted telephonically by the care staff where the program is explained in detail and the patient is given the opportunity to agree to participate. The provider is notified of patients that agree to participate in the RPM program by EMR flag/message.

Is the RPM program covered by the patient’s insurance?

Medicare, Medicare advantage and most commercial carriers cover RPM services, but deductibles and co-insurance applies, which is different per insurance provider. (During Pandemic no copays with Medicare)

Does the patient need to give consent for RPM?

Yes, the practitioner must receive the patient’s consent and document in the patient’s health record.

What are the Remote Patient Monitoring (RPM) CPT Codes?

The Remote Physiologic Monitoring (RPM) codes are:

CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”  Reimbursement Rate: Approximately $21.00 (one-time)

CPT code 99454: “16 days of Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” Reimbursement Rate: $69.00 (every 30 days per patient)

CPT code 99457: “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.” Reimbursement Rate: $54.00 (each calendar month per patient)

CPT code 99458: “Add-on code for patients who receive an additional 20 minutes of RPM services in a given month (i.e., 40 minutes of RPM services)” Reimbursement Rate: $43.00 (each calendar month per patient)

If a patient has an issue and/or vital sign threshold violations, how is this handled by the clinical call center staff? Please explain the workflow.

Call center clinical staff follow the providers protocols and workflows that include any standing order or other patient specific information. Keeping the providers EMR updated as to current ongoing care provided to the patients is important in RPM. This is accomplished by following the providers workflow or any protocols put in place and communicating with the providers for medical intervention when indicated.

How are acceptable ranges set for each patient in my Practice?

Default thresholds are set for each device and can be set according to the provider’s request per the provider’s specific protocol. Providers also can request/order settings that are patient specific as well as practice specific.

How much work for my staff to get this done?

There is no additional work required of office staff to accomplish setting up patients for RPM.

Do you look at trends to try to prevent threshold violations?

Yes. The clinical support team reviews each daily VS report and follows the provider’s protocol. Patients who consistently violate their threshold settings will be scheduled to see the provider for further evaluation. Each time a patient violates the threshold setting for a set device, the clinical staff will contact the patient and document any signs and symptoms and report those directly to the provider by following the provider’s office workflow.

When are issues escalated to the provider?

Clinical staff follow the provider’s specific workflow that are identified and documented upon implementation of the RPM program. The provider sets the program protocols and workflow as well as any patient specific protocols around escalation and notification. The workflow and protocols are built into the RPM program that are specific to that provider/practice.

How are issues escalated to the provider?

Threshold violations, patient signs and symptoms, assessment evaluations, health screenings and all incoming and outgoing calls are documented in live time. Per the provider/practice protocol, the clinical staff will escalate/report findings according to the provider workflow/protocols. The provider sets the rules for how the workflow is set or protocol is developed.

What are the response times that you expect from my office?

CMS requirement is for timely access to care, which is accomplished by the provider’s set workflow/protocols and direct provider communication when indicated. If the clinical staff doesn’t get a response in the time frame set by the provider, the staff will then escalate according to the provider’s specific protocol.

Will the practice be getting more or fewer calls directly from patients?

Patients that are enrolled in the RPM program have direct access to their RPM care staff. Care staff perform regular reviews with patients including how the care staff can support them in-between provider office visits. Patients like the direct care staff access and will utilized this method to allow the care team to support them. By building the patient centered relationship with the RPM care team, the patient incoming calls increase to the care team and decrease to the office staff phone line.

How will the care team be communicating with other providers who are providing care to my patients?

The RPM care staff will communicate with other supporting providers by sharing the patient treatment plan. The care staff will also assist the patient with scheduling their follow up visits with these provider’s as well as assist with obtaining office visit notes for review.

What are some examples of a provider’s protocols?

Patient violates VS threshold with no symptoms should be documented in the EMR for care team review.

Patients with three consecutive threshold violations are to be scheduled for tele-health visit.

Patients who are symptomatic are to be scheduled for same day office visit.

Patients enrolled in RPM are to be scheduled every 3 months for an RPM follow up.

Patients screened for fall risk that are positive for risk may be scheduled for PT evaluation.

If scheduling patients for office visits is included in service, how is this accomplished?

The care management staff is trained during implementation on how to use your practice scheduling software. The care management staff will follow the same scheduling protocol that your scheduling office staff follow. The provider may also include “special” scheduling protocols that are specific to RPM patients.

How are my patient’s medications managed?

Care staff follow the provider/practice protocols for medication management. During implementation the medication protocol/workflow is developed for patients that are in the RPM program.

How is the RPM Treatment Plan developed and by who?

The program “treatment plan” is derived from the providers encounter visit - “plan” for care – this is already developed within the providers visit encounter note. The Provider and Patient goals are part of the treatment plan.

How will the call center interact with the patients?

The 24/7 care center will interact with the patient via telephone on an ongoing basis. The staff interact with the patient via phone and other approved program methods that are non-face to face. The “month” is just the service month of accumulated billable minutes. Staff provide outreach to the patients and the patients have access to the team directly.

What is an example of the type of services that the clinical staff can provide patients enrolled in RPM?

Monitoring vital signs daily.

Patient support and monitoring of signs and symptoms.

Scheduling health maintenance such as mammogram, colonoscopy, and yearly Medicare exams.

Refilling maintenance medications such as Blood pressure medication if approved in the protocol.

Provide patient education on condition(s) as well as other health tips such as importance of dental care.

Provide screenings for depression, fall risk and many other health screenings.

Based on your experience what levels of attainment could I expect for the following:

Anelto partnered Care Management Centers on 99454, 99457, 99458?

Anelto Care Management partners have a billable rate between 80-95% for enrolled patients. High number of hospitalized patients will affect the monthly billing %. We see accounts level out around 90 days to a steady billable rate up to 95%.

My staff if I choose to do this internally?

In our experience, the scale rates tend to be lower that result in lower number of actual enrolled RPM patients. If a practice utilizes existing staff to take on RPM that sometimes results in a much lower billable rate due to lack of time to support RPM. If a practice dedicates a person per a designated case load the results are better but most find that outsourcing a solution is best for the practice and staff.

What information will you provide to facilitate Billing?

For a customer where a live interface is in place between RPM platform and EMR, the billing information is seamless. Billing encounters with all the required information is sent to the billing software for a more automated billing approach.

For a customer with no live interface, the practice billing department is provided an RPM billing report to enter charges manually. The billing report will contain all the necessary information to enter charges and submit the billing.

If I get audited, do you have the appropriate information?

Yes, we provide the RPM enrollment documentation, the monthly notes that support the billable minutes for the month, the RPM treatment plan, and all the daily VS monitoring results.

Will you handle the auditor’s questions?

Yes, we can assist with providing documentation as well as assist with any questions as needed.

Without any other physician documentation, would the practice pass a Medicare RPM audit?

Yes – when documentation is requested you provide the RPM notes to support the minutes for the month, the RPM treatment plan, the enrollment documentation, and the providers office visit encounter notes.

Do you offer billing as a service?

We can assist with a billing resource.

Can my practice see additional revenue from an RPM program?

Yes.  Please see our business proforma calculator here

Can our ACO or Managed Care Organization save money with RPM?

Yes.  Please see our ACO Calculator here