Healthcare professionals have known for decades that patients with chronic diseases, such as diabetes, hypertension, heart failure, and dementia require an exceptional level of care that involves extensive monitoring of their wellbeing and their vital statistics. Logistic restrictions and the costs involved in this monitoring activity – with insurance companies refusing to cover them more often than not – deter patients from opting in. Remote patient monitoring (RPM) is a technology that allows patients to monitor their health conditions at home and share the data with their healthcare providers in real time. RPM can improve the quality of care, reduce hospitalizations, and lower healthcare costs for patients suffering from these chronic ailments.

Unfortunately, awareness of the benefits of RPM is not quite as widespread among patients as would be desirable; patients seem to be especially not well-educated about or how to access RPM through their insurance plans. In this blog post, we will explain what RPM is, how it works, and what patients need to know about insurance coverage and reimbursement for RPM services.

What is RPM and how does it work?

RPM is a telehealth service that uses a range of devices that includes blood pressure monitors, glucose meters, pulse oximeters, weight scales, and wearable sensors, to collect and transmit health data from patients to their healthcare providers. Some RPM devices have advanced features that, based on those readings, can also provide feedback, alerts, and reminders to patients.

So how does RPM help patients manage their chronic conditions, prevent complications, and improve their quality of life? RPM can help diabetics monitor their blood glucose levels, adjust their insulin doses, and avoid hypoglycemia or hyperglycemia. The caregivers of patients with dementia can use RPM to track their cognitive function, mood, and behavior, and alert their healthcare providers in case of an emergency.

And the manner in which these healthcare providers can leverage the capabilities of RPM reduce their workload, improve efficiency, and enhance their patient outcomes is of another level altogether. Whether it’s monitoring their patients’ vital signs, ensuring medication adherence, monitoring changes in symptom changes, or intervening promptly when needed, healthcare professionals can use RPM to improve their efficiencies in all of these activities. RPM can also help providers collect and analyze large amounts of data, and use artificial intelligence (AI) to identify patterns, trends, and risks.

What are the benefits of RPM for seniors?

Oh, how can we ignore that most vulnerable of all segments of our patient population, the seniors? RPM can be especially beneficial for seniors, who often have multiple chronic conditions, mobility issues, and social isolation. RPM can help seniors – or their relatives – monitor their health status, receive timely care, and maintain their independence and dignity.

Some of the benefits of RPM for seniors include:

RPM monitoring solutions for seniors can be tailored to provide personalized and comprehensive care that meets the specific needs and preferences of each senior. RPM devices can measure blood pressure, heart rate, oxygen saturation, temperature, and activity levels, and send the data to a cloud-based platform that can be accessed by the senior, their family and, most significantly, to their healthcare team for analysis and response.
In cases of seniors suffering from dementia or cognitive impairment, RPM can help them stay safe and connected at home. Some RPM devices use GPS tracking, voice recognition, and AI to detect falls, wandering, and abnormal behaviors, and notify caregivers or emergency services.
For example, some RPM devices that use a small sensor attached to the skin to n scan the glucose levels in the interstitial fluid and send the data to a smartphone app or a receiver can help seniors with diabetes measure their blood sugar levels without the pain and hassle of finger pricks.
In some of our other blogs we have referred to the risk seniors face everyday when they try to navigate daily household routines or go out for brief chores. They fall; they suffer injuries that are sometimes fatal. AI for fall detection can help seniors prevent and respond to falls; RPM devices can use a wearable sensor that can detect the motion, orientation, and impact of a fall, and send an alert to the senior, their caregiver, or a call center.

Seniors who are prone to wandering or getting lost, such as those with Alzheimer’s disease or other forms of dementia can be kept track of using RPM devices such as a wristband, a pendant, or a watch. While upholding the vanity and self-respect of the elderly, these seemingly personal items work to track the location and movement of the senior person, and send the information to a smartphone app or a web portal where their caregiver or the relevant authorities can find their location.
Fall detection services for seniors can help seniors get immediate assistance in case of a fall. Some RPM devices can use a button, a voice command, or a motion sensor to activate a call to a 24/7 monitoring center, where a trained operator can speak to the senior, assess the situation, and dispatch the appropriate help.

The most vexing challenge that patients face comes in the form of applying for and availing insurance coverage and reimbursement for RPM; there is currently a distinct lack of clarity and consistency in insurance coverage and reimbursement for RPM services. Different insurance plans may have different criteria, policies, and rates for RPM, while some may not cover RPM at all, as reality that patients are often rudely awakened to only after they have already committed to an RPM system.

However, there are some positive signs that RPM is becoming more widely accepted and supported by insurance companies, especially in the wake of the COVID-19 pandemic, which has increased the demand and necessity for telehealth services.

Some of the things that patients need to know about insurance coverage and reimbursement for RPM are:

Medicare is the federal health insurance program for people who are 65 or older, disabled, or have certain chronic conditions. While Medicare covers RPM services for eligible beneficiaries under Part B (outpatient services), It comes with specific requirements and limitations such as the type of device, the frequency of data transmission, the duration of service, and the billing codes and may only pay a fixed amount which may not be adequate to cover the full cost of the device or the service.
On the other hand Medicaid, which is the joint federal and state health insurance program for people with low income and limited resources, does.cover RPM services for eligible beneficiaries under different programs, such as home and community-based services (HCBS) waivers, managed care plans, and state plan amendments (SPAs). However, Medicaid coverage and reimbursement for RPM vary widely by state, and some states may not cover RPM at all. It should also be noted that Medicaid has different requirements and limitations for RPM, such as the type of device, the scope of service, and the provider qualifications and may not be comparable with Medicare.
Private insurance is the health insurance that people get through their employers, the marketplace, or directly from the insurance companies. Private insurance covers RPM services for eligible members under different plans, such as preferred provider organizations (PPOs), health maintenance organizations (HMOs), and high-deductible health plans (HDHPs). Since it is based purely on the interplay of market forces, private insurance coverage and reimbursement for RPM will most likely depend on the details of contract between the insurance company and the provider, and some plans may not cover RPM at all. Private insurance also has different requirements and limitations for RPM, such as the type of device, the level of service, and the network status.

How can patients access RPM through their insurance plans?

To access RPM through their insurance plans, patients should consult in detail with their healthcare providers and their insurance companies to determine their eligibility, coverage, and reimbursement for RPM services. Some of the steps that patients should want to take are:

While consulting with their healthcare provider about their health condition, goals and preferences, they should ask explicitly if RPM is suitable and beneficial for them, and get a prescription if the provider confirms that an RPM device and service is required.
Next step, talk to their insurance company about their plan, their benefits, and their copayments, and find out if RPM is covered and reimbursed by their plan. If so, ask their insurance company to confirm and authorize the RPM device and service that their provider prescribed and ordered.
Talk to their RPM provider about their device, their service, and their payment, and ask if they accept and bill their insurance plan directly for the RPM or will the patient have to be out of pocket and claim reimbursement after filing the invoice. Most importantly, they should insist that their RPM provider explain and demonstrate clearly how to use the device, how to transmit the data, and how to contact them for support.

Conclusion

RPM is a technology that can help patients monitor their health conditions at home and share the data with their healthcare providers in real time. RPM can improve the quality of care, reduce hospitalizations, and lower healthcare costs for patients with chronic diseases, such as diabetes, hypertension, heart failure, and dementia.

However, patients may not be aware of the benefits of RPM or how to access it through their insurance plans. In this blog post, we explained what RPM is, how it works, and what patients need to know about insurance coverage and reimbursement for RPM services.

We hope that this blog post has been helpful and informative for patients who are interested in using RPM to manage their health and wellness. If you have any questions or comments, please feel free to contact us.