How to start an RPM program: questions to settle first.

Decide what the readings are for

Most advice on how to start an RPM program opens with a device vendor’s demo. Start one step earlier. Which clinical decision will the readings change? Numbers that arrive and change nothing are a cost, and unread numbers are a liability.

Write one sentence per use: the condition, the measurement and what the clinician does with it.

Medicare’s rules are described here in general terms. Other payers differ, and the monitoring codes have been revised more than once, so the practice confirms current requirements before enrolling patients or billing.

Which patients, and who orders it?

Medicare generally describes remote patient monitoring as the collection of physiologic data, such as blood pressure, weight, pulse oximetry or blood glucose, for a patient with an acute or chronic condition. It is ordered by a physician or other qualified practitioner, generally for a patient the practice already knows.

Before launch, ask:

• Which patients have a clinical reason for monitoring, not only a qualifying diagnosis?
• Can the patient or a caregiver take the reading reliably?
• Who writes the order and sets each patient’s parameters, including what counts as out of range?
• What ends monitoring: a goal reached, a set review date or a stretch with no readings?

Which device, and who handles it?

Medicare generally expects a device that meets the FDA’s definition of a medical device and that transmits readings automatically. Numbers a patient writes down and reads over the phone generally do not count.

Then ask:

1. How does it connect: a built-in cellular connection, or an app the patient has to pair?
2. Who ships it, sets it up and teaches the patient, and where is that recorded with a date?
3. Who does the patient call when it stops working? It should not be your front desk by default.
4. Who owns the device, and how are replacements, returns and cleaning handled?
5. Do readings flow into your record system, or into a separate portal someone has to remember to open?

Our page on remote monitoring devices for practices covers these trade-offs.

Who looks at the readings, and how fast?

This question decides whether the program is safe. Answer it in writing.

• Who reviews readings, on which days, and who covers absences?
• When a reading is out of range, who calls the patient, and how does it reach a clinician?
• What happens on weekends and holidays?
• Who calls patients who have stopped sending readings?

Tell patients, at enrollment and in writing, that readings are checked on the practice’s schedule and are not watched around the clock. Monitoring is not an emergency service, and an emergency means calling 911. Our patient guide on what to expect from remote monitoring at home can go home with the device.

Can you count days and minutes?

Monitoring codes rest on two counts. Device and data codes depend on how many days of readings arrive in a 30-day period. Management codes depend on time spent in a calendar month, generally including live communication with the patient or caregiver. Thresholds vary by code and have changed, so check them for each date of service.

Your records need to show, for each patient:

• The date of setup and patient education
• Days with readings in each period
• Management time, logged as it happens: date, staff member, activity and minutes

A vendor dashboard usually counts days. It rarely captures staff time unless staff work inside it. If minutes would be rebuilt from memory at month end, fix that first.

How will consent, cost and overlap be handled?

Consent is obtained and documented before monitoring starts. Decide who has the conversation, and cover cost in it. Under Medicare, the usual deductible and coinsurance generally apply, and a patient surprised by a statement tends to send the device back.

Check for overlap. Generally only one practitioner can bill RPM for a patient in a given period, so ask whether another practice already monitors. Time counted toward monitoring cannot be counted again toward chronic care management. If you are weighing both, read our CCM program startup questions too.

Pilot before you scale

Begin with one clinician, one condition and a group one staff member can follow. Run several monthly cycles, then review patients onboarded against devices shipped, days with readings, how quickly out-of-range readings were handled, and who stopped and why.

Gateway provides remote patient monitoring program support for practices in Greater St. Louis and the Metro East, covering onboarding, patient instructions and the records. Orders, review of readings, clinical responses and billing decisions stay with the practice. Reach us through the practice support inquiry form or at 314-325-0126.

Common questions

Related pages

• Remote patient monitoring support
• Remote monitoring devices
• CCM program startup questions
• Remote monitoring: what to expect
• Remote patient monitoring
• AI care program follow-up
• Documentation habits for clean claims
• Working with skilled nursing facilities