FAQ Hub: RPM Technology
Here are the commonly asked question on Remote Patient Monitoring, CCM, DMP, RPM Billing and RPM related questions
Table of Contents
DrKumo FAQs
What makes DrKumo unique?
DrKumo is a leader in secure, intelligent digital health solutions for Chronic Care, known for effortless home health monitoring and real-time data streaming. Certified by URAC for Telehealth Support Services and one of three grant winners in a $1.032 billion contract with the U.S. Department of Veterans Affairs, DrKumo sets the benchmark in Digital Health for Chronic Care offering Remote Patient Monitoring (RPM), Federal-level cybersecurity, Disease Management Protocols, AI/ML, and seamless integration with HER/EMR.
Our platform integrates AI-driven Disease Management Protocols (DMP) with advanced cybersecurity, adhering to VA Directive 6500, FIPS 140-3, and HIPAA regulations. Trusted by prestigious healthcare networks and government entities, DrKumo transforms chronic care delivery worldwide with multi-award-winning solutions that address key healthcare challenges.
(See Press Releases for awards, partnerships and CSR activities.)
What is real-time continuous monitoring, and what is its advantage?
Continuous monitoring is the live monitoring of patient data from the healthcare provider’s web console. This allows real-time insights into patient health using visualizations and analytics. With DrKumo’s platform, doctors can intervene timely, preventing health deterioration that leads to hospitalization or readmission.
(Read more: 4 Ways Continuous Real-Time Remote Patient Monitoring Saves Lives in 2022.)
What are the devices provided to patients?
DrKumo offers easy-to-use medical devices such as blood pressure monitors, glucose meters, pulse oximeters, weight scales, military-grade smartwatches, and thermometers. These devices automatically transmit patient health data via cellular connectivity without the need for an app.
How does DrKumo differ from emergency response systems?
DrKumo does not offer emergency response services. Unlike emergency systems that notify patients during a crisis, DrKumo’s Digital Health Solution for Chronic care platform is focused on preventing emergencies through consistent monitoring and self-management. It encourages patients to proactively manage their conditions and allows healthcare providers to intervene before an issue escalates into a medical emergency.
Can Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) use DrKumo’s platform?
Yes, DrKumo is fully compatible with the needs of FQHCs and RHCs, providing comprehensive remote monitoring to ensure high-quality care in underserved areas.
Remote Patient Monitoring, CCM, and DMP FAQs
Who can deliver RPM services through DrKumo?
DrKumo’s RPM platform is designed for use by physicians, qualified healthcare professionals (QHCPs), and clinical staff under the general supervision of a billing provider. This allows healthcare teams to monitor and manage patient health remotely while adhering to compliance standards.
How does DrKumo’s platform support Chronic Care Management (CCM)?
DrKumo’s platform enhances CCM by providing real-time monitoring of patients with chronic conditions, enabling healthcare providers to intervene early and adjust treatment plans as needed. This preventive approach reduces the likelihood of emergency situations and supports better overall health outcomes.
How does DrKumo’s platform integrate with Disease Management Protocols (DMPs)?
DrKumo’s platform integrates with Disease Management Protocols (DMPs) by using remote patient monitoring (RPM) technology to collect health data and provide continuous monitoring, real-time patient engagement, and clinical decision support. The integration aims to improve care coordination and efficiency, reduce symptoms, and prevent complications in patients with chronic conditions.
How do DrKumo’s RPM devices work for both patients and providers?
DrKumo’s RPM devices are user-friendly and require minimal assistance. Patients can easily monitor their health from home, and providers access the data through a secure, intuitive dashboard that includes filter functions and color-coded alerts for quick, informed decision-making.
Security and Compliance
Is DrKumo's Digital Health Solution secure?
Yes, DrKumo’s RPM technology adheres to NIST and NCCoE Cybersecurity Frameworks, implementing the essential functions: Identify, Protect, Detect, Respond, and Recover. The platform ensures that data transmission and storage are secure with advanced encryption and access controls.
(Read more: The 5 Functions Needed to Securely Implement RPM Based on NIST and NCCoE.)
What are the documentation requirements for RPM services on DrKumo?
Healthcare providers offering RPM services on DrKumo should document not only patient consent, device setup, and interactions but also the ongoing care management process. This includes detailing care plans, patient progress, and any interventions or adjustments made based on the real-time data collected. Additionally, documentation should cover when devices are deployed, any training provided to patients, and regular monitoring updates. Thorough documentation ensures regulatory compliance and supports effective, continuous care delivery.
RPM Billing and Reimbursement
How can providers get reimbursed for RPM services?
RPM services are covered by Medicare and other healthcare programs. Providers can bill Medicare using CPT codes for setup and ongoing monitoring, such as CPT 99453, 99454, 99457, and 99091. FQHCs and RHCs can also bill through HCPCS code G0511 for remote care management services, including RPM.
What are the main CPT codes used for RPM?
CPT 99453: 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
CPT 99454: 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
CPT 99457: Remote physiologic monitoring treatment services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
CPT 99458: Remote physiologic monitoring treatment services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (list separately in addition to code for primary procedure)
CPT 99091: Collection and interpretation of physiologic data (e.g. Blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
(Source: Verbatim, CMS PFS 2021, Page 84543)
What is the "16-day rule" for RPM billing?
The “16-day rule” for Remote Patient Monitoring billing refers to the requirement set by the Centers for Medicare & Medicaid Services that practitioners must collect data for at least 16 separate days within a 30-day period to bill for specific RPM services, particularly under CPT codes 99453 and 99454. This rule ensures that patients are monitored adequately before providers can submit claims for reimbursement.
Can RPM services be billed concurrently with other care management services?
Yes, RPM services can be billed concurrently with other care management services, such as Chronic Care Management (CCM), Transitional Care Management (TCM), and Behavioral Health Integration (BHI). However, providers must adhere to specific billing rules: they cannot double-count minutes spent on activities for different programs, and each program must meet its individual billing requirements. For example, while RPM can be billed alongside CCM, the time spent on RPM cannot be counted towards the time required for CCM billing. Additionally, RPM services can only be billed by one practitioner per patient within a 30-day period, even if multiple devices are used.
Legal and Regulatory Considerations
Who qualifies for RPM services?
The qualification requirements for RPM services under CMS PFS 2021 vary by code. For CPT code 99453, it covers the initial setup and patient education for remote monitoring, specifying that “monitoring must occur over at least 16 days of a 30-day period in order for CPT codes 99453 and 99454 to be billed” (Page 84543).
CPT code 99454 is for the supply of devices and data transmission, with the same requirement of at least 16 days of monitoring within a 30-day period, and it “is valued to include the medical device or devices supplied to the patient” (Page 84543).
CPT code 99091 pertains to the collection and interpretation of data, requiring “a minimum of 30 minutes of time, each 30 days” by a qualified healthcare professional (Page 84543).
CPT code 99457 involves the management of RPM services, including “interactive communication with the patient/caregiver during the month; first 20 minutes” (Page 84543).
Lastly, CPT code 99458 serves as an add-on for additional 20-minute increments of RPM management services, continuing the interactive communication requirement (Page 84543). These qualifications ensure proper monitoring and management of chronic and acute conditions through RPM services.
Who can order and bill for RPM services?
The billing provider requirements for Remote Physiologic Monitoring (RPM) services under CMS PFS 2021 state that CPT codes 99453 and 99454 “can be ordered and billed only by physicians or NPPs who are eligible to bill Medicare for E/M services”. For CPT code 99091, it “includes only professional work” and can be billed by physicians or other qualified healthcare professionals “qualified by education, training, licensure, and facility privileging”. CPT code 99457 can be billed by physicians or NPPs, and services “can be furnished by clinical staff under the general supervision of the billing physician or NPP”. Similarly, CPT code 99458 is an add-on to 99457 and follows the same rules, allowing billing by physicians or NPPs, with services furnished by clinical staff under general supervision (page 84543).
Who can furnish RPM and obtain consent?
Under the CMS PFS 2021 guidelines, Remote Physiologic Monitoring (RPM) services can be furnished by clinical staff, physicians, or non-physician practitioners (NPPs). Specifically, clinical staff may provide these services under the “general supervision of the billing physician” (Page 84544). Additionally, consent can be obtained by individuals providing RPM services, either “under contract with the billing physician or practitioner” or at the time the services are furnished (Page 84543). RPM services, such as those described by CPT codes 99453 and 99454, may also be furnished by auxiliary personnel, who may include individuals that are not clinical staff but are employees or contracted employees, provided they work under the general supervision of the billing physician or practitioner.
Can RPM be used on both new and established patients?
RPM services can only be provided to established patients, as per CMS guidelines for 2021.
Communication and Usage
How can I start my RPM program with DrKumo and onboard my patients?
Starting your RPM program with DrKumo is straightforward and can be done in just 20 minutes via phone or your preferred online platform. DrKumo provides a dedicated team to help you set up your RPM program, ensuring a smooth onboarding process for your patients. Contact us for more information and to get started.
Should the patient have a chronic condition to qualify for RPM?
According to the CMS 2021 Medicare Physician Fee Schedule Final Rule, patients do not need to have a chronic condition to qualify, but they do need to be an established patient, have 16 days of data collected over 30 days, and the RPM must be medically reasonable and necessary for their condition. The key is that the patient has an illness or injury that warrants remote monitoring, not necessarily a chronic disease.
Can multiple practitioners deliver RPM services to the same patient at the same time?
No, multiple practitioners cannot deliver Remote Patient Monitoring (RPM) services to the same patient at the same time. According to CMS guidelines, only one practitioner can bill for RPM services for a patient within a 30-day period, regardless of how many RPM devices are used. This means that even if multiple providers are involved in the patient’s care, only one can submit claims for the RPM services, and these services can only be billed after at least 16 days of data have been collected.
Miscellaneous FAQs
Can multiple practitioners deliver RPM services to the same patient at the same time?
No. Only one practitioner can bill for RPM services for a patient within a 30-day period, regardless of the number of devices used.
Can RPM devices be used in a hospital setting?
No. RPM devices are designed for home use to monitor chronic conditions. In hospitals, patients are monitored with specialized equipment, making RPM redundant.
