Once you’ve decided that you like the concept of RPM you will move into the vendor selection phase. Instead of pouring through vague website descriptions, we recommend getting your prospective vendors on the phone and asking them these 12 key questions:
Question: When was your Remote Patient Monitoring system developed? Can you provide some examples of Medicare-specific features or workflows?
Why is this important: Focus on Medicare Fee for Service Workflows
Many existing RPM solutions were developed years before the Medicare CPT codes for Remote Patient monitoring were announced in November 2018, meaning that they may not have features or workflows that are specific to Medicare. These vendors may be “stuck” supporting other workflows, which can make it more difficult for them to shift to support the Medicare workflows that you need.
Question: What percentage of your business is in the U.S.?
Why is this important: Differences in healthcare standards
Some RPM solution providers were developed abroad and are now attempting to enter the U.S. market. Like older solutions, these companies may find it difficult to support Medicare-specific workflows, both in terms of features and support. If they do 100% of their business in the U.S. it indicates a tighter fit for your workflow.
Question: Can you provide some case studies?
Why is this important: Focus on Supporting Small, Mid-Sized Practices, or Large Practices?
Some RPM solution providers have developed software that is specific to larger hospitals and health systems. These systems were often developed for hospital-centric workflows such as reducing 30-day readmissions. Because of this, they are less likely to support the workflows that are specific to Medicare or to smaller practices. If they mention hospital-specific case studies, then they have likely been focused on hospital systems that have different workflows. Ask them if they have experience working with a practice similar in size to your own. It is also important that the case study includes key data points, like patient retention and the speed they were able to get patients onboarded.
Question: What are the CPT codes that are supported in your software?
Why is this important: Find out if your provider has expert knowledge
An ideal RPM solution partner will provide knowledge and support in addition to the tools that you need to run the program, including help navigating the requirements of Medicare. The top RPM solution providers will take the time to get to know you and provide useful information that helps you to create a successful program. The worst will try to push you towards a sale before you (or they) understand what you’re doing. Companies like optimize.health will often provide free assistance with creating financial projections based on local Medicare CPT Code reimbursements, understanding the coding requirements, and providing thoughts on operational best practices. Asking detailed questions that test the salesperson’s knowledge of the Medicare CPT codes can be a great gauge of their expertise. A great follow up question could be “who do you get your CPT Code advice from to ensure compliance?”
Question: Across all your patients, what is the average time of engagement and how do you track this?
Why this is important: Retention and Reimbursement Insights
This question will again help you gain some more insight into retention but also reimbursements. As of Jan 1, 2020, CMS allows for additional 20 minute segments of time for 99458, for a maximum of 60 minutes per month. By asking this question you will get a general idea of the engagement level of patients, but also how that potentially equates to reimbursements. Be cautious if a potential partner doesn't show you financial forecasts without explaining the assumptions such as local reimbursements, utilization of CPT Codes 99457 and 99458, etc. An ideal partner will be able to show how they support patient engagement.
Question: What does your onboarding process look like? Who will be my point of contact after I sign this contract?
Why is this important: Find a partner who offers support and training
In the initial process you will likely engage with individuals to show you the features and benefits of the platform. The real question is what happens once you sign up. An ideal solution provider will not only be focused on sales, they will also have invested in a high-quality customer support team. Highly transactional companies will not have additional layers of support based on your needs. For example, is the salesperson the one doing your training? You ideally want the training for your clinical staff to be done by someone with a clinical background to provide you maximum support.
Question: Which cellular-based equipment do you offer?
Why is this important: Look for flexible equipment options
Cellular-based: Although it is more expensive, Cellular-based equipment is far easier to setup and is generally more reliable. With cellular-based equipment, there is no additional connectivity once you give the patient their device. They can simply take it and use it, with the data syncing wirelessly through the same wireless networks that cell phones and smartphones use. For this reason, cellular-based equipment can be used by patients of essentially any age.
Bluetooth-based equipment: Typically less expensive and can be used with mobile apps that the patient can use to see and track their own health data. The correct mix of bluetooth/cellular based devices will depend on the demographics of your patient population. If you plan to provide care to Medicaid patients, be aware that only 53% of those over 65 have a smartphone*. Individuals in this age group will be challenged with not only having the right equipment, but properly operating the device and ensuring the bluetooth based apps are open and ready to communicate data.
The right equipment choice depends on the patient, so it’s important to have flexible equipment options in this respect. Being locked in only having one option (e.g. only having Bluetooth-based equipment) will limit the size and success of your RPM program.
Question: Of the equipment that you offer, what do you consider to be reimbursable by Medicare?
Why is this important: Find a partner that keeps reimbursement top of mind
In order to be clearly reimbursable, RPM equipment must be collecting “physiological data (e.g. weight, blood pressure, pulse oximetry, respiratory flow rate)”. Some RPM vendors may claim that you can bill for devices that are not clearly within CMS’s definition of physiological data (e.g. fall detection devices). If a vendor suggests that this is okay then they are putting undue risk on your practice. Until CMS releases additional guidance the safest option is to stick to physiological data as it is clearly defined in the CPT code definitions as provided by the American Medical Association.
Question: Can you show me the process for setting up a patient? (Run a timer while they do!)
Why is this important: Find Easy-to-Use Software
To make the most of your program, the software should be easy-to-use and intuitive. Staff should be able to spend most of their time engaging with patients, not figuring out how to enter data into the software. If you want to maximize revenue and reduce risk it’s important to be able to get staff buy-in. An ideal system should take no longer than 3 minutes to set up a patient.
Question: Are patient alerts customizable?
Why this is important: Every patient is different
Having full control over the alerts you receive is critical because not every patient will have the same goals. Every patient is different, so the range for alerting them in case of a problem should be customizable. In addition, the notifications to escalate a potential problem to a physician should also be flexible. Look for RPM partners that allow you to set the parameters right for your medical practice.
Question: Can you walk me through how I get this information into my billing system?
Why is this important: Helps with Medicare-Specific Administrative Requirements
There are several administrative requirements specific to Medicare, including:
Keeping track of time spent for each code
Entering the correct CPT code at the right time
Assigning time spent to the correct staff member
Recording time spent communicating with patients or the care team
Systems that were designed with these specific requirements in mind will a) save your staff a lot of time and headaches b) help make sure that you don’t miss out on reimbursement opportunities c) capture records that will protect you in case of an audit by Medicare.
Question: Do I get billed even if patients aren’t using the equipment?
Why is this important: Find The Right Pricing Model
In some models, you will pay for patients even if patients aren’t actively being monitored. If your patients aren’t being monitored, then you won’t be generating any revenue from reimbursements. If a partner is trying to bill you for patients you haven’t deployed, they may not be confident that they can retain them. You want to look for partners who will help you build a successful program and who align their compensation model based on your reimbursement.
By RPM.expert Jeff LeBrun
Jeff is the co-founder and CEO of optimize.health. With over 10 years of healthcare industry expertise, he is committed to giving medical practices the tools to provide the best possible care.
“Demographics of Mobile Device Ownership and Adoption in the United States.” Pew Research Center: Internet, Science & Tech, Pew Research Center, 5 June 2020, www.pewresearch.org/internet/fact-sheet/mobile/.