These programs attract everyone from family-run rural practices to massive hospital groups, and with such a wide range of applications, there are a lot of ways this can go wrong.
Of course, no program is perfect. Your vendor can take every precaution and warn you of every possible issue, and something will still come up. And even then, not all patient monitoring vendors are created equal.
So, we put together this post to give you a good idea of what to look out for and help you learn what crucial mistakes not to make when selecting a vendor to move your clinic closer to virtual care. We recommend sharing this with your team so there are as many aware eyes as possible.
RPM Mistakes Take Different Forms
With remote patient monitoring, patients can gain access to more care, enjoy a higher quality of care, and feel support where gaps once existed. Conversely, providers can get a closer look at their patient's health data and give more timely, relevant advice based on said data. Because of this, hospitals will see reduced admissions and better patient outcomes.
It can be a great addition to your practice that everyone will relish, but that doesn’t mean mistakes can’t occur. As a vendor ourselves, we’ve seen it all. So as to make this a bit easier to digest, we’ve broken the common mistakes up into three general categories:
- Patient-related mistakes
- Code-related mistakes
- Provider-related mistakes
Another way you could look at these issues is back-house or front-house, like a restaurant. And this goes exactly as it sounds. Patient-related mistakes are things that a provider or staff member overlooked while in the room with the patient. Code-related mistakes occur when providers or staff members trip up the paperwork part of care.
If you are actively looking to adopt remote patient monitoring and you are currently talking to companies, keep these issues in mind. Your vendor might have helpful insight or will be able to recommend tools that can help mitigate risks.
Whatever you do, be sure to bring this up.
Patient-Related RPM Mistakes
At the center of this entire operation lies the body of the patients that you serve. We cannot stress the importance of minding their interests through the entire setup, start-up, and execution of your remote patient monitoring system.
Basically, all of these mistakes are avoidable and can be prevented with attention to detail. Yes, that is much easier said than done—especially in a clinical setting—so take care to reduce any room for error.
A good example of this model is an assembly line. No, caring for a patient is not like putting together a car. What we mean is including redundancies. Your team has a lot that they have to remember, so attempt to make the process as easy as possible ahead of time to save yourselves the headache later.
The top six patient-related mistakes we see all the time in remote patient monitoring programs include
- Choosing the wrong patient population
- Starting with too many patients
- Focusing on tech and NOT the patients
- Passive patients
- A lack of patient training
- Not getting patient feedback
1. Choosing The Wrong Patient Population
When we discuss how to set up your remote patient monitoring system, we harp on this point. You cannot just tell every patient you have to strap in and enjoy the ride. It will not work.
You have to be extremely careful who you start with. First, pick a parameter (and the device) you feel is the most relevant to your practice. If you are a cardiologist, you might choose blood pressure to start. You will proceed with this one parameter in mind and nothing more.
Then you choose patients that don’t hate technology, feel driven to care for their condition (healthcare professionals will know exactly what we mean here), and can be trusted to take daily readings.
2. Starting With Too Many Patients
Coming right off of #1, it is always bad to start with a giant pool of patients. For clarity’s sake, we are keeping with the cardiologist theme.
Yes, you might have a lot of patients who need to track their blood pressure, but if you hand this off to every hyper and hypo-tensive patient you have, you will regret it later.
Your first patient pool should be chosen by hand, and the pool should be small—very small if you can help it. If not, you are almost guaranteeing the failure of your program on some level.
3. Focusing on the Tech, NOT the Patients
Patients are the core of the patient monitoring world, as they should be. And when practices first step into this world, it can be very exciting. It can also be really overwhelming.
Healthcare providers don’t have a lot of time on their hands. So, they tend to cut the fat of every encounter to ensure they cover as many bases as possible. Sometimes, they cut so much down that they forget why they are doing this in the first place—to support patients.
Before bringing this to the table, you must create a solid foundation of trust and understanding with your patients, especially the sensitive ones. Also, you cannot ever take your focus off your patient population.
For example, introducing this idea to a patient cannot sound like “learn this technology because it’s good for you. Trust us.”
Rather, it should sound like “because you trust us, we are recommending this technology that we believe will support a better health outcome for you.” Support your patients first.
4. Lack of Patient Training
Supporting your patients also looks like properly training them. The average person does not have much experience with any technology used in healthcare, even monitors.
Always take the time to show your patients how to do everything. Do not leave it up to them. Even the tech-savvy ones! Just run through the uses so they can see and have some basic understanding before sending them out into the world.
This will cut down on the number of passive participants you have, as well as save your patients some confusion down the road.
Another way you can support your patients is by having infographics, pamphlets, and other kinds of content to help guide them through any questions they might have down the road. We still recommend having an introductory conversation first, but this will help, too.
5. Failing to Reinforce Daily Reading Protocol
During the Initiating Visit with your patient, make sure to reinforce the “daily reading protocol.” Just one routine reading a day makes all the difference and will lead to greater patient adherence to the program and, ultimately, more and better data for the clinic to manage the patient’s healthcare plan.
We understand that this might look like a mistake that is outside of your control, but it’s not. If you have chosen the correct patient population, the person you explain this to will understand this sentiment.
It’s the healthcare provider’s responsibility to thoroughly educate patients about every variable aspect of their care. This is a very important aspect.
Always recommend daily readings. Do not recommend a cadence that is only 1-2 readings per week. Overwhelmingly, we see this instruction lead to non-adherence altogether.
6. Passive Patients
This is very much related to the idea of mistake #1. If you don’t choose the right population for remote patient monitoring, you will have a lot of passive patients.
These are what ruin the long-term growth of patient monitoring programs.
You need people to be active in their care because you need them to be active in taking their readings. It’s as simple as that.
7. Not Getting Patient Feedback
Ultimately, these services are all about delivering better patient outcomes to your patients. While you’ll certainly want to follow the data that you receive and keep a statistic-based perspective, you and your colleagues have great opportunities to improve your RPM program by speaking with patients.
It’s very easy. It can be a quick phone call, or you can even send out polls by mail or hold surveys online.
See what they like and see what they want to be improved. Doing this work will improve the remote patient monitoring experience for both you and your patients.
Code-Related Remote Patient Monitoring Mistakes
Patient-related mistakes always harbor a good deal of risk. But code-related mistakes are going to kill your practice’s ability to keep this going faster even than patient-related ones.
1. Failing to Have a Face-To-Face Visit
Face-to-face visits are a critical first step in developing your remote patient monitoring system.
As the billing practitioner, you must have at least one face-to-face meeting with new patients or patients you haven’t seen within one year before billing CPT code 99457. CPT code 99457 is a relatively new CPT code that deals with remote physiologic monitoring treatment management services.
Ultimately, this face-to-face visit should be billed separately and can occur during things like annual wellness visits, level 2 through 5 office visits, or initial preventive physical exams.
2. Not Documenting Patient Consent
Simply put, you will need to get some documentation showing that your patients have consented to RPM. The Centers for Medicare and Medicaid Services (“CMS”) doesn’t explicitly say how you should obtain documented consent.
Nonetheless, it is critical to have documentation that shows patients are actively opting in for RPM treatment. It’s also a good idea to have documentation in the patient’s medical record that shows why RPM is justified.
3. Failing to Use the Correct CPT Codes
Like providing other types of healthcare services, it’s critical to use the correct CPT codes when providing remote patient monitoring care. While the first CPT code in the RPM world was introduced in 2018 (CPT code 99091), there have been several additional CPT codes added in the final 2019 and 2020 Medicare Physician Fee Schedules, so please make sure you’re using the updated codes from 2021 and onward.
CPT 99453, CPT 99454, CPT 99457, and CPT 99458 are the better codes to use when providing Remote Patient Monitoring services to your Medicare beneficiaries.
Make checking in and updating all code-related protocols an annual or biannual occurrence. Better safe than sorry!
4. Not Using Medical Devices as Defined by the FDA
The 2019 Medicare Physician Fee Schedule requires that billing practitioners use FDA-defined “medical devices” to bill for RPM services. You can find the FDA definition of “medical devices” by clicking here.
Ultimately, you’ll want to make sure that devices within your patient monitoring program comply with this definition. Notably, however, your device does not necessarily need to be “FDA-approved.” While it certainly won’t hurt, the guidance doesn’t seem to suggest that this is a strict requirement.
5. Failing to Have Patient Monitoring Services Ordered by Physicians or Other Qualified Healthcare Professionals
When delivering RPM care to a patient, it is important to have those services initially ordered by physicians or other qualified healthcare professionals.
The good news for healthcare providers is that physicians and other qualified healthcare professionals don’t necessarily need to deliver services after the initial order. For instance, clinical staff can provide services under CPT codes 99457 and 99458. The actual act of ordering RPM services, however, cannot be completed by clinical staff.
6. Failing to Track Interactive Time (or worse, doing it Manually)
This is a notable mistake when you are trying to get reimbursed by Medicare. Specifically, CPT codes 99457 and 99458 can only be billed if clinical staff members, physicians, or other qualified health care providers spend at least 20 minutes interpreting a patient’s physiologic data and using that data to manage or adjust the patient’s care plan. CPT code 99458 requires at least 40 minutes with these tasks.
Consequently, make sure that you are monitoring this time. As a best practice, use a third-party platform that tracks this interactive effort automatically, and that can serve as evidence in case of a Medicare inquiry.
7. Failing to Capitalize on the Rules Around “Incident-To” Billing
Under CPT codes 99457 and 99458, clinical staff members can provide RPM services as long as they are supervised under the general supervision of the billing practitioner. CPT codes 99457 and 99458 allow for “general supervision,” meaning that the billing practitioner does not need to be in the same office building as the staff member delivering care.
This means that you can embrace an auxiliary model when delivering remote patient monitoring services.
8. Double Billing Interactive Time with Analogous Medical Services
When billing under CPT 99457 and 99458, you may also bill in conjunction with certain CCM, TCM, and behavioral health integration services codes. That being said, you must ensure that you aren’t counting the same interactive time for more than one billing code. For example, if you spend 20 min providing Remote Patient Monitoring services, those 20 minutes of time cannot also be allocated to Chronic Care Management Codes.
Remember, you cannot count any time on a day when you report an evaluation and management service for the same patient. All of the above mistakes should be accounted for in your practice’s protocols. It’s in your best interest to have as many alert eyes as possible.
Provider-Related Mistakes
We understand that this is a strange title. Technically, all of these mistakes are related to the provider, but categories are helpful, so here we go.
1. Staff Overwhelm & Lack of Resources
Patient monitoring systems are built to help your team, but they can easily become too much when managed improperly. In order for your staff to support your patients, your staff needs to be supported as well.
You really can’t pour from an empty cup. So, how do you support your team?
Take the time to train them in all things remote patient monitoring. Give them the chance to make mistakes in a safe setting where they can learn and form new habits. Make content that helps them help your patients.
This endeavor needs to be seen as helpful and beneficial to everyone, including your staff. Let them know ahead of time that this change is coming. Discuss it with them and find out everyone's opinion. Do not let doubt sit and fester.
Do not throw this on their plate and then push them out of the nest. Your program will fail.
2. Delayed Response
Any virtual system needs to be an extension of your practice, like an addition to a building. It cannot exist as a separate entity. You’ll need to consider a way to be flexible about patient follow-ups in the case of an off reading.
The remote patient monitoring company you work with should have an integration package that makes this part is as easy as possible for you and your team.
Why Do These Matter?
Any providers reading this will know that mistakes in healthcare happen because of a breakdown in communication, either written or verbal. Our best piece of advice for anyone looking to counter these possibilities is to document, document some more, and then make as detailed of a procedure as you can.
You also need to be supporting your staff as much as possible because they are footing a lot of this mental bill.
Remote patient monitoring was made to make your life easier, but those easy times generally come after a few shaky months of adoption. It’s worth it but tread carefully.
As you can see, many of these mistakes are completely avoidable. You and your colleagues have the power to avoid them—so long as you are paying attention. This diligence, however, will absolutely pay off. By avoiding these unforced errors, you and your colleagues will be able to utilize the benefits of RPM services. To learn about RPM and what mistakes not to make, visit accuhealth.tech.
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