Alaska does not give healthcare leaders much room for theoretical planning. Distance, weather, workforce shortages, and uneven broadband access turn every care model into an operational test. That is why understanding the pillars of the RHTP funding in the state of Alaska and the benefits of the Dr. Miltie N9+ matters for providers, administrators, and rural health decision-makers trying to build programs that can actually function outside a major urban center.

For organizations serving frontier communities, tribal populations, school-age children, families managing chronic conditions, and patients who cannot easily travel, funding is only useful when it supports care delivery that is clinically credible and sustainable. The best-aligned technologies are not generic video tools. They are platforms that help extend examination capability, improve care coordination, support reimbursement-aware workflows, and fit the realities of rural and community-based care.

What RHTP funding in Alaska is really trying to support

When healthcare teams talk about rural transformation funding, the conversation often drifts toward hardware purchases or one-time grant activity. That is too narrow. In Alaska, RHTP-related priorities are better understood as a set of practical pillars that shape whether a program can improve access and stay viable after the initial funding period.

The first pillar is access expansion. In Alaska, access is not just about adding appointments. It means reducing the need for long-distance travel, bringing care closer to schools and community clinics, and giving clinicians a way to evaluate patients who might otherwise delay care. A virtual care strategy that only adds a video visit without clinical examination tools may help with convenience, but it may not close the access gap in a meaningful way.

The second pillar is care model modernization. Rural transformation efforts increasingly favor technologies that let organizations redesign workflows rather than simply digitize old ones. That includes clinician-directed virtual exams, remote patient monitoring, care coordination, and support for distributed care settings such as homes, schools, pediatric practices, and satellite clinics. In Alaska, where workforce reach matters as much as workforce size, modernization is tied directly to operational resilience.

The third pillar is measurable community impact. Funding programs are more compelling when they can show improvements in follow-up rates, chronic disease oversight, pediatric access, reduced avoidable transfers, and better continuity of care. Leaders need tools that generate clinically relevant data and help document outcomes, not just activity.

The fourth pillar is financial sustainability. This is where many otherwise promising programs become fragile. Rural organizations need implementation models that recognize reimbursement, staffing constraints, and the realities of care delivery across multiple settings. A technology investment that requires extensive new labor or sits outside billable workflows can become difficult to defend, even if the clinical idea is strong.

The fifth pillar is equity for underserved populations. In Alaska, this includes rural communities, safety-net populations, and pediatric patients whose needs are amplified by travel burdens, caregiver limitations, sensory stress, or specialist scarcity. Programs that support care in familiar environments can be especially valuable for autistic children and pediatric patients with special healthcare needs.

The pillars of the RHTP funding in the state of Alaska in practice

If those pillars sound broad, that is because they are meant to guide real implementation decisions. The question for health systems, critical access hospitals, FQHCs, rural health clinics, and community-based organizations is what kind of platform can support all of them at once.

A standard telehealth setup may satisfy a narrow access goal, but it often falls short on exam depth, documentation quality, and care team integration. That trade-off matters more in Alaska than in denser markets. When patients face major travel barriers, a limited virtual encounter can still leave providers needing an in-person follow-up that is difficult to schedule and harder for families to attend.

A more capable model supports clinician-directed virtual physical exams, capture of objective patient data, remote monitoring, and pathways for follow-up care. This is where the benefits of the Dr. Miltie N9+ become operationally relevant rather than promotional.

Benefits of the Dr. Miltie N9+ for Alaska care delivery

The Dr. Miltie N9+ is not just a telehealth endpoint. It is a mobile, wireless virtual examination and patient monitoring system designed to extend clinical reach beyond the traditional exam room. For Alaska organizations, that distinction matters because the gap is rarely access to communication alone. The gap is access to clinically useful examination capability in places where patients already are.

One major benefit is stronger remote assessment. When a provider can conduct a more complete virtual physical exam and collect clinically relevant data, the virtual encounter becomes more actionable. That can improve triage decisions, support earlier intervention, and reduce unnecessary travel for cases that can be safely managed closer to home.

Another benefit is better fit for pediatric and family-centered care. Children, especially those with autism or special healthcare needs, may do better in familiar, lower-stress environments than in a distant clinic or hospital. A connected-care model that supports evaluation in homes, schools, or community settings can improve cooperation, caregiver participation, and follow-through. For families in Alaska, that also means fewer disruptions tied to weather, transportation, and missed work.

The platform also supports care continuity across distributed settings. That is valuable for chronic care management, post-discharge follow-up, school-based support, and ongoing monitoring for patients who do not need constant facility-based visits but do need structured oversight. In rural and frontier environments, continuity is often where outcomes are won or lost.

There is also an efficiency benefit for providers and administrators. A technology that combines connected medical devices, workflow customization, and care coordination support can help organizations extend limited clinical staff more effectively. That does not mean virtual care replaces hands-on care. It means the right patients can be seen in the right setting, with better use of specialist time and fewer low-value transfers.

Why the N9+ aligns with Alaska RHTP priorities

The clearest reason the N9+ aligns with the pillars of the RHTP funding in the state of Alaska is that it supports both clinical and administrative goals. On the clinical side, it helps organizations bring examination and monitoring capabilities into community-based settings. On the administrative side, it supports more scalable program design, especially when paired with reimbursement-aware deployment.

That balance is important. Some health technology performs well in a pilot but struggles in broad deployment because it requires too much customization, too many disconnected systems, or too much manual coordination. In Alaska, where operating conditions are already complex, healthcare organizations need platforms that reduce friction rather than add to it.

The N9+ also fits the needs of rural and safety-net organizations serving populations with uneven access to specialists. A rural clinic, critical access hospital, or pediatric program can use connected-care tools to bring more of the assessment process closer to the patient while still involving the broader care team. Through a Circle of Care approach, caregiver engagement and cross-setting coordination become part of the model instead of an afterthought.

Where healthcare leaders should be careful

Not every use case will deliver the same return. Organizations should avoid treating funding as a reason to buy technology first and define workflows later. The better approach is to start with service lines where travel burden, exam complexity, follow-up gaps, or pediatric access barriers are already clear.

It also depends on readiness. A strong virtual care platform still needs training, internal champions, clinical protocols, and attention to reimbursement and documentation. Leaders should assess staffing models, patient population needs, and site-level infrastructure before scaling broadly.

There is a practical middle ground here. The goal is not to virtualize everything. It is to identify where a clinician-directed remote exam and monitoring model can improve access, reduce friction, and preserve quality. In Alaska, that often means using technology to extend care intelligently, not universally.

A stronger case for rural transformation

For healthcare organizations pursuing rural transformation, the case for investment gets stronger when technology can speak to multiple funding pillars at once. Access, equity, pediatric support, operational efficiency, care continuity, and financial sustainability should not live in separate business cases.

That is why the benefits of the Dr. Miltie N9+ stand out for Alaska-based planning. It supports more complete virtual care, helps providers reach patients in community settings, reduces barriers for families, and gives organizations a more credible path from pilot activity to durable care delivery.

For Alaska leaders, the real opportunity is not to fund another isolated telehealth project. It is to build a care model that works where roads are long, specialists are scarce, and patients still deserve timely, clinician-directed care close to home.

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A blood pressure reading that trends upward over five days may not look urgent in isolation. To a remote patient monitoring nurse, it can be the early signal that keeps a patient out of the emergency department, prompts a medication review, or triggers a same-week follow-up before a chronic condition worsens. That is the practical value of this role. It sits at the point where clinical judgment, patient engagement, and connected-care infrastructure meet.

For healthcare organizations expanding virtual care, the remote patient monitoring nurse is no longer a niche position. It is becoming a core operational and clinical function, especially in programs serving chronic disease populations, rural communities, pediatric patients with ongoing monitoring needs, and patients who benefit from care delivered at home, school, or other lower-stress environments.

Why the remote patient monitoring nurse role matters now

Remote patient monitoring, or RPM, has matured beyond simple device distribution. Health systems and community-based providers are under pressure to improve access, manage staffing constraints, support value-based care goals, and create financially sustainable care pathways. That changes what organizations need from nursing teams.

A remote patient monitoring nurse does more than review incoming numbers. The role often includes triaging physiologic data, identifying when values fall outside patient-specific parameters, communicating with patients and caregivers, escalating concerns to prescribing clinicians, documenting interventions, and supporting adherence over time. In a strong program, the nurse helps turn data into action rather than letting dashboards become passive repositories of readings.

This matters even more in rural and safety-net settings. When patients face long travel distances, clinician shortages, or transportation barriers, the nurse becomes a clinically meaningful bridge between the patient and the broader care team. In pediatrics, the role can also reduce strain on families by supporting follow-up in familiar settings and involving caregivers more directly in monitoring routines.

What a remote patient monitoring nurse actually does

The day-to-day work varies by organization, patient population, and technology model. Still, several responsibilities define the role across most RPM programs.

Reviewing and interpreting patient data

At the center of the role is the review of patient-generated health data. That may include blood pressure, pulse oximetry, weight, temperature, glucose values, or other condition-specific metrics. The nurse is not simply checking whether a number is high or low. Context matters. A mildly elevated reading in one patient may be less concerning than a smaller change in another patient with heart failure, complex pediatrics, or recent medication adjustments.

The best programs support this work with configurable alert thresholds and clinically relevant workflows. Even then, the nurse still applies judgment. False alarms, missing readings, and normal physiologic variation can all create noise. A useful RPM workflow helps nurses distinguish meaningful trends from device friction or one-off anomalies.

Engaging patients and caregivers

A remote patient monitoring program succeeds or fails on participation. Nurses often spend substantial time helping patients understand why readings matter, how and when to take them correctly, and what to do if symptoms change. In pediatric care, that engagement extends to parents, guardians, school staff, and other members of the care circle.

This is especially important for autistic children and pediatric patients with special healthcare needs. Monitoring may need to fit the child’s environment, communication style, and sensory preferences. The nurse’s role becomes part clinical support and part care coordination, with a strong emphasis on reducing disruption while preserving the quality of follow-up.

Escalating care at the right time

One of the most important functions of a remote patient monitoring nurse is timely escalation. Not every alert requires a physician call, and not every symptom can wait for the next scheduled visit. The nurse helps determine what needs education, what needs care coordination, and what needs immediate clinical review.

That middle layer is operationally valuable. It protects physician time, supports continuity, and creates a more responsive patient experience. It also reduces the risk that subtle deterioration goes unnoticed between visits.

Documenting for clinical and reimbursement integrity

RPM is a care model, but it is also a regulated service line. Nurses working in these programs often support documentation tied to care plans, patient communication, time-based service requirements, escalation pathways, and care coordination activities. If documentation is weak, the program may struggle clinically and financially.

That is why many healthcare leaders look for platforms and workflows that are reimbursement-aware from the start. A nurse should be able to focus on patient care without chasing fragmented data across systems.

Where this role creates the most value

Not every organization will structure RPM nursing the same way. The highest value usually appears where there is a combination of ongoing monitoring need, access friction, and a patient population that benefits from more frequent touchpoints.

Chronic disease management

Patients with hypertension, diabetes, heart failure, COPD, and other chronic conditions often benefit from trend-based monitoring rather than episodic office visits alone. The nurse helps identify deterioration earlier, reinforce treatment plans, and support adherence between appointments.

Pediatric and family-centered care

In pediatric programs, RPM nursing can support follow-up without requiring repeated travel or disrupting school and caregiver schedules. For children with special healthcare needs, the nurse may coordinate around developmental, behavioral, or environmental considerations that make in-person monitoring harder. That flexibility can improve participation and reduce missed follow-up.

Rural and community-based care

For rural health clinics, critical access hospitals, federally qualified health centers, and community-based organizations, the nurse can extend the reach of limited clinical teams. Instead of asking every patient to return for every concern, organizations can use remote monitoring to maintain visibility into patient status while reserving in-person capacity for those who truly need it.

What healthcare leaders should consider before hiring or scaling

It is tempting to think of the remote patient monitoring nurse as a staffing add-on. In practice, the role works best when it is designed into the care model from the beginning.

First, technology fit matters. If devices are difficult for patients to use, data transmission is inconsistent, or virtual exam tools are disconnected from nurse workflows, the burden falls back on staff. Nurse efficiency depends on clinically useful device integration, dependable data capture, and clear escalation logic.

Second, patient population fit matters just as much. A pediatric RPM workflow should not mirror an adult cardiac workflow. Rural programs may need more caregiver coaching and outreach persistence. Safety-net settings may need stronger support for language access, digital confidence, and care coordination across fragmented resources.

Third, organizations should be realistic about alert design. Too many alerts create fatigue. Too few can miss meaningful change. The right balance depends on condition, acuity, staffing model, and physician oversight.

Fourth, reimbursement and compliance cannot be afterthoughts. RPM programs require operational discipline around consent, documentation, time tracking where applicable, HIPAA-aligned workflows, and clinical oversight. A good nurse can strengthen the program, but no nurse should be expected to compensate for a weak implementation model.

The technology question: data alone is not enough

Many RPM programs start with connected devices and stop there. That can produce data, but not necessarily better care. Nurses need more than raw numbers. They need enough clinical context to assess what the reading means, enough communication capability to reach the patient or caregiver, and enough workflow support to move efficiently from observation to intervention.

This is where connected-care platforms can make a measurable difference. When remote monitoring is paired with virtual exam capability, care coordination tools, and customizable workflows, the nurse role becomes more clinically complete. In some settings, that means combining monitoring with clinician-directed virtual assessment rather than sending the patient to another site simply to confirm what a trend already suggests. For organizations building pediatric, rural, or distributed care models, that broader approach is often more practical than piecing together multiple disconnected tools.

A role that strengthens the whole care team

The remote patient monitoring nurse should not be viewed as a replacement for in-person nursing or physician care. The better way to see it is as a force multiplier for clinical teams trying to manage more patients across more settings with greater continuity.

When the role is well supported, nurses can identify change earlier, guide patients more consistently, improve caregiver participation, and help organizations use virtual care in a way that is clinically credible and operationally sustainable. That is particularly relevant for healthcare leaders building programs around chronic care management, pediatric access, and rural health equity.

For many organizations, the real question is no longer whether remote patient monitoring has value. It is whether the program has the nursing workflows, clinical tools, and care model design to turn that value into daily practice. Getting that part right is what makes virtual care feel less remote for the people who depend on it most.

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As the adoption of telehealth, remote monitoring, and connected care technologies continues to increase, it’s important for healthcare leaders to stay on top of the latest updates in telehealth reimbursement. 

Some of the most significant updates come from the Centers for Medicare & Medicaid Services (CMS), which released its final rule for Medicare payments under the Physician Fee Schedule (PFS) in 2024. Let’s delve into the eight key updates impacting telehealth and remote patient monitoring (RPM) services:

1. Established Patient Requirement: A fundamental change concerns new patients seeking RPM services. Before initiating these services, a new patient evaluation and management (E/M) or similar service is now mandatory. This ensures a clear care plan is established during an in-person visit. However, exceptions exist for patients who utilized RPM during the Public Health Emergency (PHE) as they already have an established patient-provider relationship. Additionally, this established patient rule doesn’t apply to remote therapeutic monitoring (RTM) reimbursement.

2. 16-Day Data Collection for RPM: The billing guidelines for RPM data collection have been revised. Now, healthcare providers need to collect data for at least 16 of the 30-day episode of care period, excluding calendar month days, for CPT codes 99453 and 99454. This clarifies the data collection requirements for accurate reimbursement of these specific codes.

3. Clarity on RPM/RTM “Time Spent”: CMS has provided further clarity regarding time spent billing guidelines for specific CPT codes. Codes 99457, 99458, 98980, and 98981, representing “time spent” for treatment management, are not subject to the 16-day data collection requirement. They maintain their existing billing guideline of a 30-day calendar month.

4. One Provider for RPM/RTM Billing: A significant update concerns the number of providers permitted to bill for RPM and RTM services. According to the new guidelines, only one provider can bill for either RPM device codes (99453 and 99454) or RTM codes (98976, 98977, 98980, and 98981) within a 30-day episode of care. This means the provider who submits the claim first will be reimbursed, whereas subsequent claims from other providers for the same patient during that period will be denied.

5. Concurrent Billing with Other Services: Reimbursement for RPM and RTM cannot be combined with similar services within the same month. However, specific services like Chronic Care Management (CCM), Transition Care Management (TCM), Behavioral Health Integration (BHI), Principal Care Management (PCM), and Chronic Pain Management (CPM) can be billed concurrently with either RPM or RTM.

6. Billing During Global Surgery Periods: The 2024 Physician Fee Schedule clarifies the permissible timeframe for billing RPM/RTM services during a surgical global period, defined as the time during which a physician cannot bill for related office visits. Now, if the billing provider for RPM or RTM services is different from the provider receiving the global payment, these services can be billed. Additionally, if RPM or RTM services were already in place before the surgery, CMS allows payment outside the surgical global period.

7. FQHCs and RHCs Gain Reimbursement: This update presents new opportunities for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). They can now receive reimbursement from CMS for either RPM or RTM services (not both) when billed alongside Care Management CPT code G0511. This code can be billed multiple times per calendar month, offering additional financial support for these healthcare facilities.

8. New Cost Fee Structure: The final update concerns changes to the cost fee structure. While the specific details are outside the scope of this article, it’s important to be aware that individual CPT code reimbursement rates for RPM, CCM, and RTM have been slightly adjusted.

These updates highlight the ongoing evolution of telehealth and remote patient monitoring regulations. By staying informed about these changes, healthcare providers and facilities can ensure they are delivering compliant and reimbursable care to patients while optimizing their practice efficiency.

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Hospitals across the nation are facing financial constraints and unprecedented staffing shortages. This situation is compounded by the growing need to provide skilled, resource-intensive care for sicker patients being admitted to hospitals’ general care units.

This situation is not only impacting clinical staff, who are overworked, stretched thin and reporting high levels of burnout, but patients, who are more likely to experience a harmful safety event due to inadequate working conditions.

“The intersection of fewer providers and sicker patients is challenging hospitals a great deal,” said Dr. Sam Ajizian, Chief Medical Officer of the Patient Monitoring Operating Unit at Medtronic.

A powerful, impactful strategy to address this challenging landscape is for hospital leaders to leverage technology, specifically remote monitoring, connectivity, and interoperability solutions.

The impact of remote monitoring

Technology — particularly, remote patient monitoring — provides clinical staff with a significant gift: more time with patients.

Right now, clinicians spend far too much of their shift on administrative tasks such as manual charting. They continuously check routine vital signs and manually input the information into the electronic medical record, leading to short, stressful and unsatisfactory interactions with patients.

Remote patient monitoring automates some of this work for caregivers by enabling the continuous capture of vital patient data, which is then uploaded to the EMR and put in the hands of caregivers in the most convenient format for them, such as on a desktop, mobile app or tablet.

As a result, remote patient monitoring can help reduce burnout for clinicians as it decreases the need for manual charting and supports more one-on-one time with patients.

“Remote patient monitoring frees up a lot of nursing hours^3,5 where they can do what they went into the profession for — to talk to patients and give care. No provider went into healthcare to type on a computer,” Ajizian said.

The continuous capture of real-time patient data also allows clinicians to identify adverse patient trends earlier and intervene sooner, helping them improve patient outcomes overall.

In order to gather this data from patients continuously, the monitoring device, such as a wearable, must be comfortable for patients to wear. The BioButton multi-parameter wearable from BioIntellisense, part of Medtronic’s HealthCast portfolio, is small, with a self-adhesive, worn on the patient’s upper left chest, with up to 16 days of battery life. “The BioButton device offers an effortless user experience. Just stick it on and forget it” Ajizian said.   

The important role of connectivity

While the device used to continuously capture patient vital sign information is key to the success of remote patient monitoring programs, so is connectivity. Clinicians must be able to access patient data anytime, anywhere, quickly and easily.

“You can have the best wearable in the world but if the data can’t be displayed where the caregiver wants it and how they want to see it, it’s useless,” Ajizian said.

To achieve this, remote patient monitoring systems should be part of the existing ecosystem of devices and workflows, including the hospital’s EMR.

The HealthCast^TM Vital Sync^TM remote patient monitoring system allows clinicians to remain connected to their patients wherever they are in the hospital. The system is designed to connect to hospitals’ EMRs and existing devices. Additionally, it provides clinicians with actionable insights through near real-time trend and alert data on patients wherever they prefer to see it including via desktop or mobile app.   

The future of remote monitoring

Choosing a remote monitoring platform is a significant financial investment. In addition to considering the product features, hospitals should also factor in the quality of the partnership with the provider.

Hospitals must prioritize finding a partner that will offer long-term clinical, technical, education and maintenance support that puts patients and clinicians first. Medtronic understands the importance of partnering with hospitals to build sustainable remote monitoring programs.

“We meet the customer where they are, we fill in the gaps with the tech and we connect it in the easiest way possible,” Ajizian said.

Learn more about Medtronic’s HealthCast^TM intelligent patient monitoring, a portfolio of remote monitoring, connectivity and interoperable solutions, here.

Footnotes

1. Baker MA, Sands KE, Huang SS, et al. The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections. Clin Infect Dis. 2022;74(10):1748-1754.
2. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sentinel-event-general-information-and-2021-update.pdf
3. Bellomo R, Ackerman M, Bailey M, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. Aug 2012;40(8):2349-61.
4. Stellpflug C, Pierson L, Roloff D, et al. Continuous physiological monitoring improves patient outcomes. Am J Nurs. 2021;121(4):40–46.
5. Han WH, Sohn DK, Hwangbo Y, et al. Effect of a Wireless Vital Sign Monitoring System on the Rapid Response System in the General Ward. J Med Syst. 2022;46(10):64. Published 2022 Aug 26.
6. Downey C, Randell R, Brown J, Jayne DG. Continuous versus intermittent vital signs monitoring using a wearable, wireless patch in patients admitted to surgical wards: pilot cluster randomized controlled trial. J Med Internet. Res. 2018;20(12):e10802
7. Eddahchouri Y, Peelen RV, Koeneman M, Touw HRW, van Goor H, BrediS JH. Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study. Br JAnaesth. May 2022;128(5):857-863.
8. Verrillo SC, Cvach M, Hudson KW, Winters BD. Using Continuous Vital Sign Monitoring to Detect Early Deterioration in Adult Postoperative Inpatients.J Nurs Care Qual. Apr/Jun 2019;34(2):107-113.
9. Weller RS, Foard KL, Harwood TN. Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients. J Clin Monit Comput. Oct 2018;32(5):945-951.

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Executive Summary

Digital health advocates believe remote monitoring—the use of digital technologies to collect and relay patient data to health care professionals—has the potential to transform disease management, health outcomes, and patient care, especially for individuals with multiple chronic conditions who lack convenient access to providers. Medicare, most state Medicaid agencies, and many private health insurance plans cover remote monitoring services.

For the purposes of this report, we define remote monitoring as an umbrella term for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM). RPM refers to the monitoring of physiologic data—such as weight, blood glucose, or blood pressure—while RTM refers to the monitoring of patients’ self-reported non-physiologic data, such as pain levels or medication adherence. Currently, the Centers for Medicare & Medicaid Services (CMS) limits RTM reimbursement to cases involving the respiratory system, musculoskeletal system, and cognitive behavioral therapy.

Although the percentage of patients using RPM remains relatively low (594 monthly claims per 100,000 Medicare enrollees in 2021), the use of RPM increased among Medicare beneficiaries more than sixfold from 2018-2021. In part, this increase was due to CMS’ expanded coverage rules during the COVID-19 public health emergency. Thirty-four state Medicaid programs covered RPM services as of March 2023; however, many Medicaid programs restrict RPM use in some way. RTM uptake has also steadily increased since its introduction in 2022, yet billing and documentation requirements can hinder its widespread adoption.

The evidence base on remote monitoring, particularly for RPM tools, is growing. Yet some policy experts cite a lack of robust evidence on the optimal use of remote monitoring, including its duration and target patient groups. In the absence of such evidence, these experts question whether we are effectively “rightsizing” the use of these services. Underuse could limit access to beneficial care, while overuse could unnecessarily increase spending in federal health care programs. Additionally, providers cite the need for tools—such as generative artificial intelligence (AI)—to manage streams of data, otherwise the volume of patient-generated information can become overwhelming and unmanageable.

Over the past year, the Bipartisan Policy Center undertook an extensive effort to develop evidence-based, federal policy recommendations for the appropriate use and coverage of remote monitoring services. BPC assessed patients’ access to and use of remote monitoring technologies and their impact on health outcomes and cost. We conducted a series of interviews and hosted a private roundtable with health policy experts, federal officials, technology leaders, medical providers, payers, consumers, and academics to gain insight into the opportunities and challenges regarding remote monitoring.

This report looks broadly at ways to improve the use of remote monitoring services, ensure equitable access to these services across populations, and enhance data security and privacy standards. Now is the time for payers and providers to refine their approach and maximize appropriate adoption for patients who stand to benefit from remote monitoring.

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The next generation of healthcare will have a face that will likely be much different than anything seen before. The push to rapid innovation, especially in the wake of COVID-19 pandemic, resulted in solutions that provided new outlook in the way healthcare is supervised. As all the industries adjusted to working remotely, healthcare has been more benefitted than most with this shift, where doctors and other clinicians turned to emerging technological solutions in order to keep up with growing demand for healthcare services while keeping patients safe.

Remote Patient Monitoring And Telehealth: The Growth Story

Telehealth had already been a prevailing practice that was beneficial for patients located in remote areas. It was swiftly leveraging technology, providing on-demand consultations to patients. However, the epic pandemic brought its awareness at great extent. It became the silver lining, as government-imposed lockdowns and transmission of the virus restricted physical human interactions. Since in-person visits had to be avoided due to the significant increased risk to patients, telehealth services were rapidly adopted which greatly helped in expanding the access to healthcare. The global telehealth market is likely to witness a growth rate of nearly 24% through 2023-2035.

New solutions to telehealth not only helped healthcare providers to see patients through, but also provided patients with faster, more accurate and complete care. Solutions did not only just expand to texts, phone calls, image forwarding, video consultations, but went further to remote patient monitoring and robust patient health portals. Remote patient monitoring emerged as a significant strategy for telehealth globally, creating robust opportunities for companies that largely dealt outside of the traditional healthcare technology. As per our analysis, the global remote patient monitoring market is estimated to cross a revenue of USD 36 Billion by the end of 2033.

Challenges

Technological innovations have fostered the potential of telehealth. The most effective benefit of telehealth services is the convenience and ease of access, for both healthcare providers and patients. With leveraging technology such as smart wearables and smart home communication systems, telehealth services have improved in the quality and quantity of care provided to consumers. Smart devices provide direct and relevant patient data, and allow constant daily remote monitoring, resulting in obvious benefits to patient care. Along with improved quality, it also improves patient behavior by creating a system where people are more engaged with and responsible for their health. It has also given people a sense of assurance and comfort that someone is watching over their health and well-being on a daily basis.

The Changing Face Of Healthcare

The healthcare industry, today, has created an environment where consumers can demand quality services, lower costs, and easy and convenient access to services. Telehealth has emerged as an innovative and valuable strategy to provide quality healthcare services at lower costs with an easy and effective accessibility. As the most straight-forward initiatives toward revolutionizing digital health, the telehealth market is expanding as new companies are emerging with new and more innovative solutions to improve the potential of telehealth services. Remote patient monitoring is the most effective trend which has changed the competitive and relationship dynamics of telehealth industry, and will continue to be very active as the industry expands with new solutions coming in together. Some of the recent trends that is predicted to shape the future of telehealth services are:

• Telemedicine program in the United States are rendered by over 51% healthcare organizations.
• Telehealth improves the service quality of the treatment provided to the patients, claims about 50% of the healthcare organizations globally.
• While deciding for treatment, more than 55% of the patients feel that their involvement has increased significantly in the decision-making process as a result of the benefits associated with telehealth.

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In November 2023, CMS issued final rules for the 2024 Medicare Physician Fee Schedule (MPFS) and the 2024 Medicare Outpatient Prospective Payment System (OPPS). Both of these rules contained finalized policy proposals that will impact rural health clinics (RHCs) beginning in January 2024:

• Telehealth Flexibilities
• Medicare Coverage of Marriage and Family Therapists and Mental Health Counselor Services
• Intensive Outpatient Program (IOP) Services Billable in RHC Under Special Payment Rule
• Expansion of RHC Care Management Services
• Definition Change to Nurse Practitioner

Telehealth Flexibilities

CMS has officially extended some telehealth flexibilities that were allowed during the public health emergency (PHE) to continue through December 31, 2024. Specifically, CMS finalized the following:

• RHCs may be reimbursed for telehealth services utilizing CPT code G2025
• Removed the originating and geographic site requirements, which allows patients to be located in any location during the telehealth visit. This would include the patient’s home. It should be noted that telehealth services are to be provided during the RHC’s operating hours
• Delayed the in-person requirement for mental health visits performed via telehealth
• Extended audio-only coverage allowance for telehealth services
• Expanded the list of telehealth distant site providers to include Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)

New Billable RHC Provider Types

MFTs and MHCs have now been officially added as qualified RHC provider types. An MHC is an individual who:

• “(A) possesses a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor under the State law of the State in which such individual furnishes the services described in paragraph (3);
• (B) is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the State in which the services are furnished;
• (C) after obtaining such a degree has performed at least two years of clinical supervised experience in mental health counseling; and
• (D) meets such other requirements as specified by the Secretary.”

Effective January 1, 2024, MFTs and MHCs will be able to generate Medicare encounters and be reimbursed for those services at the RHC’s all-inclusive rate (AIR). MFTs and MHCs also have the ability to meet the requirement that a provider must be available to provide care to patients at all times the clinic is open.

Intensive Outpatient Program (IOP) Services

IOP services are outpatient mental health services that are designed for patients who require more complex mental health care than would be able to be accomplished during a typical office visit, but not so severe that an inpatient mental service would be required. These services are intended for patients with acute mental illnesses such as depression and substance abuse disorders who require a higher level of care. In its proposal, CMS specified the services eligible to be provided and reimbursed under an IOP may include:

• Individual and group therapy with physicians, psychologists, and other mental health professionals as available under state law
• Occupational therapy
• Furnishing of drugs and biologicals for therapeutic purposes that are not self-administered
• Family counseling (as part of treatment of the patient’s condition)
• Patient training and education
• Individualized activity therapies
• Diagnostic services
• Other related services for diagnosis and active treatment intended to improve or maintain the patient’s condition and function

To quality a patient for IOP services, a physician is required to certify that a patient needs behavioral health services for at least nine, but no more than 19 hours per week. That certification must be completed by a physician at least once every other month for the patient to continue to qualify for services and the plan of care must demonstrate that the patient:

• Requires at least nine hours of therapeutic services per week
• Is likely to benefit from coordinated services rather than individual sessions of outpatient treatment
• Does not need 24-hour care
• Has a support system outside of the IOP
• Has received a mental health diagnosis
• Is not a danger to themselves or others
• Has the cognitive and emotional ability to tolerate the IOP

IOP services will not be reimbursed at the RHC’s AIR, but rather under a special rule that would allow for a flat payment of approximately $280 per day. RHCs will be allowed to perform up to three services per day and to qualify for the special payment, at least one of the three services must be from Table 44 Proposed Partial Hospitalization and Intensive Outpatient Primary Services found on page 367 of the HOPPS Proposed Rule.

Because IOPs are a new service for RHCs, there is an expectation of future rulemaking outlining how services may be provided and reimbursed.

Expansion of RHC Care Management Services

Historically, RHCs have only been allowed to bill and be reimbursed for Care Management Services, including Remote Patient Monitoring, Remote Therapeutic Monitoring, or using CPT code G0511 or G0512 once per month per beneficiary. Under the new final rule, RHCs may now bill G0511 multiple times per month as long as the services rendered are “medically reasonable and necessary, meet all requirements, and not be duplicative of services paid to RHCs and FQHCs under the general care management code for an episode of care in a given calendar month.” In addition, CMS has finalized the establishment of new care management codes for Community Health Integration (CHI) and Principal Illness Navigation (PIN), which also will be billed to Medicare using the G0511 code and those services will be reimbursed as long as a qualified provider performs the service.

Definition Change to Nurse Practitioner

CMS has changed the definition of a nurse practitioner to state that an individual must “be certified as a primary care nurse practitioner at the time of provision of services by a recognized national certifying body that has established standards for nurse practitioners and possesses a master’s degree in nursing or a Doctor of Nursing Practice (DNP) doctoral degree.” This change allows individuals certified by additional certifying boards, including the American Academy of Nurse Practitioners Certification Board, American Nurses Credentialing Center Certification Program, Pediatric Nursing Certification Board, and the National Certification Corporation, to now meet the definition of a nurse practitioner as long as the other requirements are met.

These changes may result in significant operational, revenue cycle, and regulatory reimbursement impacts for RHCs beginning in January 2024. If you have any questions about the new requirements or would like assistance in evaluating the organization’s readiness and potential impact, please reach out to a professional at FORVIS.

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In this article, you’ll learn the differences and rates between RTM billing codes and RPM billing codes for 2024. CMS released the CY 2024 Physician Fee Schedule Final Rule in November 2024. The final rule includes 3,000 pages of detailed policy changes related to remote therapeutic monitoring (RTM) and remote patient monitoring (RPM) Medicare reimbursement. This article breaks down the final rule and provides key takeaways for the RTM billing codes and RPM policy updates, set to begin on January 1, 2024. 

RPM and RTM Billing Codes in 2024

Remote therapeutic monitoring (RTM) and remote patient monitoring (RPM) remote track and report on non-physiological patient data, including vital signs, medication and exercise adherence, functional status, response to therapy, and respiratory and musculoskeletal activity. Understanding the billing codes for these new remote care services can be confusing.

Remote therapeutic services allow patients to receive treatment guidance, support, and interventions outside the traditional in-office setting. These services may include counseling via video chat, text messaging programs aimed at medication adherence, virtual physical therapy sessions, and more. The goals are to increase access to care and improve outcomes.

New revenue streams opened to healthcare providers in November 2022 when the American Medical Association (AMA) created 5 CPT codes for RTM services: 98975, 98976, 98977, 98980, and 98981. The codes comprise three practice expense-only codes: 98975, 98976, and 98977, and two codes for treatment management: 98980 and 98981.

Remote patient monitoring allows providers to track vital signs, symptoms, medication adherence, and more outside of the office. This aims to detect early warning signs and prevent bigger problems. The billing codes for RPM are: 99453, 99454, 99457, 99458, and 99091.

Now that we’ve reviewed what remote therapeutic monitoring is, we will provide a quick overview of billing updates for 2024. 

RPM and RTM Billing Codes 2024

The 2024 Physician Fee Schedule Final Rule provisions clarify remote therapeutic monitoring services requirements. The codes account for the extra time needed for planning, data analysis, and interacting with patients outside of direct contact. Overall, there are a few key takeaways regarding RTM billing codes in 2024. 

Only One Provider Bills in RTM and RPM

CPT codes 99453 and 99454 and RTM billing codes 98976, 98977, 98980, and 98981 may be billed by only one clinician over a 30-day period. This is per episode of care and not per calendar month.  Therefore, if more than one provider bills for RPM or RTM services in the same month, the first provider to submit the claim will be reimbursed. The other claim (s) will be denied. 

RPM and RTM Billing Codes and Other Services 

RPM and RTM cannot be billed together during the same month. However, some services can be billed with either RPM or RTM concurrently. These are as follows:

• Chronic Care Management
• Transition Care Management
• Behavioral Health Integration
• Principal Care Management
• Chronic Pain Management

Global Surgery Period

A global period is when a physician can not bill for related office visits. However, RTM and RPM services are permitted when the billing provider of the services is not the provider who receives the global service payment. When a patient receives RTM or RPM services before a surgical procedure, CMS will pay for the RTM or RPM services outside of this global period.

FQHCs and RHCs 

The 2024 Physician Fee Schedule allows new reimbursement opportunities for FQHCs and RHCs, allowing them to receive reimbursement for RPM and RTM services. However, only one of these services can be billed under CPT code G0511. Furthermore, it can be billed multiple times each calendar month at the rate of $72.98.

The following section explains exactly what the 5 RTM billing codes cover in 2024, including the average reimbursement rate and requirements.

RTM Billing Codes and Reimbursement Rates for 2024

As of 2022, CMS adopted 5 RTM billing codes to pay for device setup, collection, interpretation, and processing of remote non-physiological data. The following section explains exactly what the 5 RTM CPT codes cover in 2024, including average reimbursement rate and requirements. These rounded numbers are based on non-facility national averages and vary by region.

98975

This code covers initial setup and patient education on the use of equipment. It can be billed once in a 30-day period when at least 16 days of data is collected on at least one medical device. The average national payment rate for CPT 98975 is $19.65.

98976

Billing CPT code 98976 pays for respiratory devices supplied with daily scheduled recordings and programmed alerts and transmission for monitoring the respiratory system. The code can be used every 30 days when at least 16 days of data have been collected on at least one medical device. The average national payment rate for CPT code 98976 is $46.83.

98977

Code 98977 reimburses musculoskeletal devices supplied with daily scheduled recordings and programmed alerts and transmission for monitoring the musculoskeletal system. This can be billed once by one practitioner only when at least 16 days of data have been collected on at least one medical device. The average national payment rate for CPT code 98977 is $46.83.

98980

CPT 98980 bills for the initial 20 minutes of treatment time per calendar month. Time must include at least one interactive communication via phone or video with the patient during the month.

CPT 98980 can be billed “incident to” or under general supervision, which includes physicians, nurse practitioners (NPs), and physician assistants (PA). CPT 99457 is billed monthly. The average national payment rate for CPT 98980 is $49.78.

Notably, billing is not generally part of the Medicare benefit for qualified healthcare practitioners: physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs). Second, RTM services must be personally furnished by the billing qualified health care practitioner. When the practitioner is a PT or OT, a therapy assistant must be under the supervision of the OT or PT.

CPT 98981

In 2024, CPT 98981 covers each additional 20 minutes of treatment time per calendar month. This code has the exact requirements as CPT 98980.  The average national payment rate for CPT 98981 is $39.30.

What are the differences between RTM and RPM?

Remote patient monitoring (RPM) is different from remote therapeutic monitoring. As previously mentioned, RPM and RTM differ because RTM focuses on non-physiological monitoring. On the other hand, RPM focuses on physiological data. Providers can choose from a growing list of FDA-cleared remote patient monitoring devices and software services.

Remote patient monitoring enables the monitoring of patient vital signs outside of conventional clinical settings, such as at home or in remote areas. This telehealth service allows patients to take measurements from their homes. Once the measurement is taken, the data is sent in real-time to providers to measure physiologic data such as heart rate, weight, oxygen saturation, pulse rate, glucose levels, and more.

 Over recent years, CMS created RPM billing codes for reimbursement for digital health, which has expanded Medicare reimbursement for remote patient monitoring. This is a separate category from RTM billing codes and services. These 5 RPM CPT codes are 99453, 99454, 99457, 99458, and 99091. 

RPM and RTM Billing: 2024 RPM Key Takeaways

What are the key takeaways for medical professionals regarding RTM and RPM billing for 2024? Although future modifications to remote patient monitoring CPT codes are expected, CMS did not add the Proposed Rule RPM G codes to the final rule. CMS further establishes rates and provides yearly guidance on requirements and utilization for remote monitoring services.

As a result, these are the 3 key takeaways for RPM in 2024:

• No new RPM CPT codes appear in the final rule for 2024.
• Medicare non-facility reimbursement rates were updated for 2024
• RPM providers will continue to use CPT codes 99453, 99454, 99457, 99458, and 99091.  

RPM 2024 CPT Code Reimbursement Rates

As of 2020, CMS adopted RPM CPT codes to pay for device setup, collection, interpretation, and processing of remote physiological data. This section explains exactly what the 5 RPM CPT codes cover in 2024, including the average reimbursement rate and requirements. These rounded numbers are based on non-facility national averages and vary by region. These are different from RTM billing codes.

99453

Just as RTM billing codes cover device setup, this code pays for device set-up and patient education on the use of equipment for vital sign monitoring such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate, and weight. Only one clinician bills this one-time code after the initial 16 days of monitoring in a 30-day period. The average national payment rate for CPT 99453 is $19.65.

99454

Supplying the device for daily recording or programmed alert transmissions is billed under code 99454. It may be used more than once, given that the patient uses the device at least 16 days per month. One clinician can bill CPT 99454 in a 30-day period. The average national payment rate for CPT 99454 is $48.63.

99457

This payment is for the initial 20 minutes of treatment management. An unspecified portion of that 20 minutes must involve interactive remote communication with the patient. However, how interactions must be provided is not explicitly defined. However, we assume a video call, phone call, email, and text messaging would suffice. The average national payment rate for CPT 99457 is $48.14.

Moreover, CPT 99457 is billed “incident to” under general supervision. Medicare providers can contract third-party remote patient monitoring companies to assist with RPM services. Ultimately, healthcare organizations can manage more patients and generate more revenue without significantly impacting workflows. 

99458

In 2024, CPT 99458 encompasses each additional 20 minutes of RPM services, with a maximum of 60 minutes in a calendar month. Similar to CPT 99457, documentation of how the time is distributed is required. The average national payment rate for CPT 99458 is $38.64.

99091

CPT 99091 was new in 2022 but had more requirements than the preceding codes. In 2024, it covers a minimum of 30 minutes in a calendar month for the time it takes clinical staff to gather, interpret, and process data that a patient transmits. It also covers at least one communication, which occurs by phone or email, whereby medical management or monitor advising occurs. The average national payment rate for CPT 99091 is $52.71.

Understanding RPM and RTM Billing Codes

Remote therapeutic monitoring and remote patient monitoring are two distinct categories of remote monitoring services with specific CPT codes and billing requirements. A key difference between RTM and RPM is that RTM focuses on tracking non-physiological patient data like medication adherence, while RPM follows vital signs and physiological metrics. The 2024 Physician Fee Schedule Final Rule provides clarification and billing guidance for providers offering these services starting January 1, 2024.

Importantly, RPM and RTM billing codes cannot both be used to bill for the same patient in the same month – only one clinician can submit claims. Additionally, reimbursement rates differ across the codes. As remote monitoring continues growing in healthcare, having a firm grasp of the respective CPT codes, rules for utilization, and payment rates will ensure appropriate delivery and billing of RPM and RTM services.

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On November 2, 2023, in the 2024 final rule for the physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) finalized crucial policies impacting remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services reimbursed under the Medicare program. This article breaks down the key takeaways of the Medicare final rule 2024 to guide companies through the changes and clarifications.

Medicare Final Rule 2024: RPM Exclusive to Established Patients

The Medicare final rule 2024 emphasizes that RPM services can only be furnished to “established patients.” This distinction, reinstated after the Public Health Emergency (PHE), requires patients who started RPM services during the PHE to become “established patients.” Those initiating RPM services after May 11, 2023, must undergo an initial evaluation to qualify.

This re-establishment of the “established patient” requirement aims to maintain a structured approach to RPM services, ensuring a foundation of familiarity with the patient’s health history and treatment plan.

RTM’s Unique Position

In contrast, RTM services offer flexibility and do not mandate an “established patient” requirement. While an initial interaction evaluation is advisable, the Medicare final rule 2024 clarifies that an established patient relationship is not expressly required for RTM services, with potential future rulemaking to address nuances.

This flexibility in RTM requirements allows practitioners to adapt their approach based on the unique needs of patients, potentially streamlining the onboarding process for remote therapeutic monitoring.

Medicare Final Rule 2024 Billing for RPM and RTM 

In the Medicare final rule 2024, CMS clarified that certain remote monitoring codes necessitate at least 16 days of data collection in 30 days. Treatment management codes (99457, 99458, 98980, and 98981) do not adhere to the 16-day requirement, offering practitioners greater flexibility.

This clarification on data collection requirements ensures practitioners understand the expectations for different remote monitoring codes. It also addresses concerns raised during the rulemaking process about the potential burden of a uniform 16-day requirement across all codes.

In a given 30-day period, only one practitioner can bill RPM/RTM services for a patient, even with multiple medical devices. This clarity ensures streamlined billing processes while aligning with CMS’s emphasis on reasonable and necessary services.

In the Medicare final rule 2024, the emphasis on singular practitioner billing aims to avoid confusion and potential overlapping claims, ensuring that one healthcare professional coordinates each patient’s remote monitoring services.

Billing RTM for Assistants Under General Supervision

Physical therapists (PTs) and occupational therapists (OTs) can now bill Medicare for RTM services according to the Medicare final rule 2024. This includes those provided by their assistants (PTAs and OTAs), with the requirement of general supervision. The change facilitates broader access to RTM services within private practice settings.

These expanded billing capabilities for PTs and OTs underscore the importance of incorporating a diverse range of healthcare professionals in the delivery of remote therapeutic monitoring. It recognizes the collaborative nature of healthcare and the contributions of various team members.

Concurrent Billing with Care Management Services

According to the Medicare final rule 2024, practitioners can bill Medicare for RPM or RTM concurrently with certain care management services, avoiding double counting of time and effort. This strategic approach allows practitioners to tailor patient care management services without compromising compliance.

The ability to concurrently bill for remote monitoring and other care management services reflects CMS’s commitment to providing comprehensive and coordinated healthcare. It encourages practitioners to leverage a combination of services to meet the diverse needs of patients.

Global Surgery Period in the Medicare Final Rule 2024

Billing practitioners cannot bill Medicare for RPM or RTM services during global surgery periods. However, practitioners not receiving global service payments, such as therapists, can provide these services during the global period, ensuring flexibility in patient care.

This distinction in billing practices during global surgery periods aims to balance the financial considerations for practitioners while focusing on patient care continuity. It encourages healthcare providers to adapt their billing strategies based on their specific patient treatment roles.

Separate Reimbursement: FQHCs and RHCs

Starting January 1, 2024, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can separately bill Medicare for RPM and RTM services, departing from the previous all-inclusive rate model. This change aims to enhance reimbursement and align with coding requirements.

The shift towards separate reimbursement for FQHCs and RHCs reflects a recognition of the unique challenges and services provided by these healthcare entities. It offers financial flexibility and acknowledges its role in delivering remote monitoring services to Medicare beneficiaries.

RPM Exclusion from MSSP Primary Care Services

While CMS considered including RPM CPT codes in the Medicare final rule 2024, the definition of primary care services for the Medicare Shared Savings Program (MSSP) ultimately chose not to. The concern lies in potential conflicts when specialists also bill RPM codes, affecting the assignment of primary care services under MSSP rules.

This decision reflects CMS’s commitment to maintaining the integrity of primary care services within the MSSP framework. By excluding RPM codes from the definition, CMS aims to prevent potential disruptions in assigning primary care services and ensure accurate representation in the program.

Understanding the Medicare Final Rule 2024

The Medicare final rule 2024 marks a milestone in the evolution of RPM and RTM Medicare billing. Despite increased clarity, some operational uncertainties persist, emphasizing the need for stakeholder engagement in future rulemaking to enhance the utilization of these services in advancing digital health models for patients.

We hope you have found these key takeaways helpful in further understanding the nuances within the Medicare Final Rule 2024. As healthcare providers navigate the evolving landscape of remote patient monitoring and therapeutic services, staying informed and actively participating in future rulemaking processes will be essential for optimizing patient care and compliance with CMS guidelines.

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Enforcement Policy for Non-Invasive Remote Monitoring Devices Used To Support Patient Monitoring; Guidance for Industry and Food and Drug Administration Staff

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