What Patients Are Eligible for Remote Patient Monitoring?

Remote patient monitoring eligibility depends on a number of factors—including insurance or Medicare coverage.

October 28, 2022
What Patients Are Eligible for Remote Patient Monitoring?

Remote patient monitoring (RPM) provides a number of compelling benefits for healthcare providers and their patients. For patients, RPM means a streamlined and efficient process for acquiring care, with less travel and fewer in-person appointments. Healthcare providers similarly benefit, as they can offer more timely personalized care and reduce their own costs through improved processes.

RPM provides a way for facilities to combat the $3.5 trillion annual healthcare costs in the United States that goes toward treating chronically ill patients. Knowing that figure, it makes perfect sense why RPM would be such a growing industry. 

There’s healthy demand for RPM, too. Just how big is the remote patient monitoring market? According to an Insider Intelligence study, “70.6 million US patients, or 26.2% of the population, will use RPM tools by 2025.” The remote patient monitoring market is expected to be worth $6.42 billion by 2030, which is a nearly 20% compound annual growth rate (CAGR), between 2022 and 2030).

How, exactly, can RPM reduce costs for healthcare providers? And what are some common remote patient monitoring use cases—and who’s eligible for this type of care? This blog will answer some of the most frequently asked questions, including these.

How Does CMS Define Remote Patient Monitoring?

The Centers for Medicare & Medicaid Services (CMS) defines remote patient monitoring as the “use of digital technologies to collect health data from patients in one location and electronically transmit that information securely to providers in a different location.” In this context, when they refer to a patient’s “health data” they are referring to things like their vital signs, weight, blood pressure, blood sugar, pacemaker information, etc.

What Qualifies as Remote Patient Monitoring?

Anytime a patient’s health data is collected remotely—rather than requiring an in-person doctor’s visit—it qualifies as RPM. In fact, most people who need these devices already own them, things like blood pressure cuffs, heart rate monitors, scales, and blood glucose monitoring devices. 

What Is the Difference Between Telehealth and Remote Patient Monitoring?

Remote patient monitoring is simply one specific type of telemedicine, characterized by the use of electronic devices that collect information without requiring the patient to visit a medical facility. More generally speaking, other types of telehealth include face-to-face, real-time audio and/or video-based visits, case-based teleconferencing, and mobile health (or “mHealth,” which provides patients with virtual access to their personal health data via their smartphones).

Who Qualifies for Remote Patient Monitoring?

In its early stages, RPM was really only utilized for patients with chronic illnesses, but eligibility soon expanded to also include high-risk patient care (for those with multiple comorbidities) and acute care (to monitor symptoms to detect deterioration).

A patient’s eligibility (for reimbursement) is determined by their insurance company’s policies, so there is some variation. For patients with Medicare, the policies are more definite, requiring an established patient-physician relationship and clear patient consent to use RPM devices and have their information monitored remotely.

In late 2020, CMS remote patient monitoring guidance was updated to expand the types of patients and conditions that qualify for RPM—making it more accessible and affordable for interested patients. 

In order to provide RPM for patients, providers need to follow a few steps:

  1. Enroll the patient. The patient needs to have an existing relationship with a provider, who may encourage a routine physical exam, laboratory tests, or other preventative care measures. The patient should also have at least one acute or chronic condition that can be monitored through RPM.
  2. Get consent. Before asking patients to utilize RPM devices, providers need to establish consent (ideally, written) and set expectations. 
  3. Provide instruction. Depending on the type of RPM device(s) needed for effective monitoring, providers may need to teach the patient how to properly use them. 

Does Medicare Pay for Remote Patient Monitoring Devices?

Yes, in most cases Medicare will cover the cost of approved RPM devices, provided they are determined to be a reasonable, necessary component of patient diagnosis and care. Devices must also conform to FDA standards for medical devices, as described in Section 201(h) of the Federal, Food, Drug, and Cosmetic Act.

Is Remote Monitoring Suitable for All Patients?

While telehealth and remote monitoring applications are usually a matter of the provider’s judgment and expertise and determined on a case-by-case basis, CMS does offer guidance around the types of care that generally are—and are not—appropriate for these types of care.

  • “Likely appropriate” uses include general wellness visits, chronic condition management, discussion of test results, prescriptions, mental health counseling, and more.
  • “Less appropriate” uses include health conditions that require a medical procedure, abdominal pain, eye complaints, gynecological complaints, highly-nuanced or complex conditions, and any type of situation where a physical examination would significantly help in effectively diagnosing a patient’s condition (and potential treatments).

Jumpstart Your RPM Program with Harmonize Health

Harmonize Health uses innovative, user-friendly technologies to integrate RPM programs into clinical workflows. This leads to better patient outcomes, more streamlined care, and significant cost savings for providers and facilities. As a result, healthcare providers who use our platform  see a 61% reduction in hospital admissions, and over $7,000 saved, per patient per year.

Learn more about how Harmonize Health empowers providers to deliver efficient, remote care. Or, request a demo to see how we can help you streamline your workflows, deliver excellent care, and significantly reduce costs.

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