Remote Patient Monitoring Frequently Asked Questions

A new clinic can be live with us in as fast as 24 hours, although with training and EHR integration, the typical onboarding period is 3 to 5 business days.

Book an appointment with one of our client specialists using this link. Our client specialist will make sure that you understand the program and get your onboarding information loaded into our system so that you can get started quickly.

Accuhealth offers a nationwide English-and Spanish-speaking team of nurses and MAs who provide first-line clinical monitoring of all vital sign data being captured by patients 24/7/365. When a patient’s biometric data exceeds a critical threshold (see below), our team will call the patient using our platform, on a recorded line, and make a clinical assessment. Our nurse will determine if the case needs to be escalated to the physician and, if so, make contact with the physician. This sort of screening can help significantly reduce the burden of “noise” so that ordering physicians can deploy RPM with less stress and headache.

Many vendors do not offer any sort of clinical monitoring, leaving the clinic to have to respond to every single abnormal vital sign reading, even overnight.

Accuhealth offers physicians the ability to set both custom default thresholds for each vital sign (such as blood pressure, heart rate, or glucose), as well as custom thresholds for individual patients—because we’re not all the same!

Some vendors are not able to offer the level of customization that physicians should expect.

No, the device does not need to be "FDA-approved," but it must be a "medical device" as defined by the FDA. The FDA defines “medical device” as “an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is . . . intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease . . .”.

Our interpretation is that NO, RPM cannot be done with self-reported data. 

We provide the first device for each patient as part of our service, and the majority of patients only need one device.

Many vendors may ask you to incur a major capital expense and purchase a large number of devices up front.

Accuhealth pays for and supplies all consumables to patients because it’s a key part of our patient compliance strategy.

Many vendors don’t offer or manage consumables, leading to lower patient compliance.

Although Bluetooth is great for non-critical technology, because of pairing, smartphone/tablet requirements, WiFi, accounts and password issues, we have found that the easiest and most reliable devices are those with built-in cellular chips that avoid all the complexity of Bluetooth and instead send their data wirelessly to our platform without any patient interaction. These devices cost us more money, but we believe in offering the easiest experience to our clients and their patients.

Many vendors rely on outdated Bluetooth devices because they are inexpensive. However, because patients will inevitably have issues with pairing, unpairing, logins, passwords, or WiFi connectivity, Bluetooth often leads to lower long-term compliance with RPM.

We manage all device storage, fulfillment, shipping, and returns. We never expect physicians to store devices in their office or have to spend time distributing devices to patients.

Some vendors require physicians to purchase and store a large number of devices in their office and manage the distribution of the devices to their patients.

Accuhealth already integrates with more than 10 of the top practice-based EHRs, and we’re always adding more integrations. If you have any of the following, we already integrate with your EHR:

Athenahealth
ECW (eClinicalWorks)
Greenway
Practicefusion
Nextgen
eMDs
Integrated Practice Solutions
Dr Chrono
Aprima
Kareo
Waiting Room Solutions
Any web-based EHR

We will even build EHR integration with some non-web-based EHR’s (Epic, Cerner).

Many vendors don’t integrate with any EHRs or if they claim they do, their integration isn’t robust or real. See the next question.

Our EHR integrations allow you to:

- order RPM directly from the EHR
- review patient readings (like blood pressure) in the vital sign fields
- see trends and run reports, which is especially important for quality reporting
- generate automatic claims for RPM

Many vendors claim they integrate with EHRs, but what they actually do is just upload a PDF or fax document into the patient chart. Since that data is not readable automatically by the EHR, this is not a true integration and also prevents the provider from running reports that are required for quality reporting.

Zero. We do it at no cost because we know each new integration is an investment that makes our product offering more attractive to our clients.

Many vendors charge $5,000 or more for EHR integration, and that usually means they don’t actually offer it.

Accuhealth has a proprietary HIPAA-compliant SOC 2- certified platform called Evelyn. Evelyn is a web-based solution in which providers and their clinical team members can log in to see all their patients’ RPM data, monitor compliance, see and add clinical notes, review billing data, and more.

Many vendors do not have a fully integrated HIPAA-compliant software solution that connects devices to clinicians.

No. Billing practitioners can only report CPT Codes 99091, 99454, 99457, and 99458 once per billing period regardless of the number of parameters monitored or devices used.

All monitoring, comments, and phone calls made to patients through the Accuhealth platform are automatically timestamped and recorded and become a permanent part of the audit record. This audit record is stored in the Accuhealth platform as part of the patient’s medical record and is also integrated with the patient’s medical record in the ordering provider’s EHR. This audit record includes the actual recorded audio files of the phone calls with patients and transcripts of those calls. We believe we have the best audit record in the industry.

Many vendors have minimal to no audit trail or their audit trail might be manually produced, creating the opportunity for human error and additional risk to the practice.

Yes, your clinical team can log in to Evelyn, our web-based RPM platform, at any time and review live patient readings.

All of the time that we accrue towards you billing RPM is captured automatically—no manual entry required or even possible. Our system automatically tracks every reading that is checked off as reviewed, every comment that is made, and every phone call that is made, and it auto-calculates the appropriate time for each event and logs that time.

Medicare, Medicare Advantage, Texas Medicaid (under the name of "telemonitoring" with different codes than Medicare), and some private payers. For Medicare, RPM is a Part B service.

99453, 99454, 99457, 99458

99453 - Initiating visit with the patient to describe the program and get patient acceptance to participate. Typically, this is when the patient is provided with an Accuhealth brochure. This is a one-time billable code, and the Date of Service is equal to the first successfully recorded reading that comes into Evelyn for the respective patient. This code reimburses typically between $15 and $20 depending on the locality.

99454 - This is for providing the monitoring device(s) to the patient, the software to ingest readings from the patient, and ensuring that both are functioning on an ongoing basis. This code is billed once every 30 days. The patient must record at least one successful reading in the 30-day period. The first date of service for 99454 is equal to the first successfully recorded reading in Evelyn and is billed every 30-day calendar days subsequently. This code typically reimburses $55 to $62 depending on locality.

99457 - This is for providing between a minimum of 20 minutes of interactive telemonitoring services with the patient and/or patient caregiver over the calendar month. This time can be provided incident to and under the clinic's general supervision, meaning Accuhealth can provide 100% of this time. It’s encouraged that clinics work within our platform, as any time spent by the clinic also goes towards this cumulative time. This code reimburses ~$49 across most localities.

99458 - This is for providing additional units of 20 minutes of cumulative interactive time spent providing telemonitoring services to the patient and/or patient caregivers. There is no limit to how many units of 99458 a clinic can bill; however, it’s legally recommended NOT to exceed more than two units of 99458. In other words, if a clinic records 40 to 59 minutes of time with a patient in a calendar month, they would submit a claim for 99457 and one unit of 99458. If a clinic spends 60 or more minutes, they would submit a claim for 99457 and two units of 99458. This code reimburses typically about $49 for each unit across most localities.

Use the CMS tool: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

Not exactly. 99453 is a one-time code. 99454 is an every-30-day code, not to be confused with 99457 and 99458 which are calendar month codes.

99453 can only be billed after 16 days of monitoring.

99454 should be billed only once each 30 days, regardless of the number of parameters monitored.

Do not report any RPM codes in conjunction with 99091 (legacy remote patient monitoring code).

RPM can be billed in the same months as CCM, TCM, and BHI (but time spent doing one service, e.g., CCM, cannot also count towards time for another service (RPM)).

Do not count any time on a day when the physician or qualified healthcare provider reports an evaluation/management service.

Do not count any time related to other reported services (e.g., 93290).

May be billed as an "incident to" service.

Billing provider must have at least one face-to-face visit with the patient in the preceding 12 months (this rule was relaxed during the COVID-19 PHE to allow for the face-to-face to be done via telemedicine). Face-to-face visits can include levels 2-5 E/M visits, Annual Wellness Visit, Initial Preventive Physical Exams, or the face-to-face from a Transitional Care Management encounter.

Billing provider must be a Qualified Healthcare Provider (QHCP = MD, DO, NP, PA).

No. If there is a more specific code, you must use the more specific code.

No, you can not round time up.

The ordering provider should document that the patient has given consent for the program. The consent itself can be verbal, but the provider should document that consent was obtained. This is especially important for patients with Original Medicare because they will be responsible for 20% of the claim that the provider generates (unless their secondary insurance covers it).

The CMS has grouped RPM as part of CCM, but the State of Maryland has a special program (MDPCP) that bypasses that. Clinics that are part of the MDPCP program are not allowed to bill for CCM, but they are allowed to bill for RPM.  

Reference: https://health.maryland.gov/mdpcp/Documents/MDH%20MDPCP%20Billing%20Resource%20Guide%20Sept.%202019%20FINAL

We ship devices to patients using tracking numbers, and once the device has arrived, we call the patient to onboard them onto the program. We help them take their first measurement and make sure that their data is flowing appropriately into our platform.

Some vendors require the clinic staff to train patients on device usage.

We have a robust Patient Adherence program that includes the following:

- we pay for all the consumables (for some patients this is a big deal)
- when we call patients, we try to call with the same clinical team member if possible in order to develop comfort and rapport
- we enroll patients into our Bingo game in which patients can win prizes by participating in taking daily measurements
- we use automated SMS reminders

Some vendors will just give you the device and expect you to figure out all the downstream issues yourself. If patients stop participating after just one or two months, your program will fail.