5 Recommendations to Improve RPM Adoption

Remote patient monitoring (RPM) has the potential to improve clinical outcomes by giving providers the ability to improve care management outside the hospital or doctor’s office, but its growth is being stymied by low reimbursement.

A report released earlier this year by the Bipartisan Policy Center gives the government and the healthcare industry a blueprint to address that roadblock.

While RPM has seen tremendous growth coming out of the pandemic, its future is in question. The Centers for Medicare & Medicaid Services (CMS) offers only a handful of CPT codes for remote physiological monitoring and remote therapeutic monitoring, enabling care providers to recoup, according to one study, as much as $170 per patient per month from Medicare. To make matters worse, the American Medical Association’s CPT Editorial Panel, which governs CPT codes, has hit a roadblock on new codes that would expand reimbursement opportunities.

The reimbursement issue could prompt healthcare organizations to avoid launching or expanding RPM programs, figuring the effort to support the program is too much for the amount of money that would come back in.

• CMS should work with medical specialty societies to evaluate the evidence and determine appropriate coverage mechanisms to guide the optimal use of RPM, including for which patients and over what duration. This work could include collaborating with Medicare Administrative Contractors (MACs) or issuing National Coverage Determinations (NCDs).
• As more evidence emerges about the appropriate use of RPM devices, the Health and Human Services Secretary should recommend a diverse set of billing codes so providers have more options for the time they spend on the data and the number of minimum days of data required.
• CMS should clarify current policies regarding appropriate coding and billing of RPM and RTM. It should also require providers not enrolled in risk-based models to attest to medical necessity for patients’ continued use of remote monitoring—at a frequency deemed appropriate by the HHS secretary and based on condition-specific clinical guidelines.
• CMS should work with the AMA and relevant medical specialty societies to develop additional RTM billing codes to allow for use cases beyond musculoskeletal, respiratory, and cognitive behavioral therapy—as the evidence supports.
• Congress should request the Medicare Payment Advisory Commission (MedPAC) to report on the impact of remote monitoring on clinical outcomes and cost by disease state, and on any new billing thresholds or code durations, at least every three years.

The goal of these recommendations is to move the needle forward on RPM and give more healthcare organizations—especially smaller hospitals and health systems with limited resources and those working with underserved populations—a chance to expand their reach.