WHAT IS REMOTE PATIENT MONITORING?

Remote patient monitoring (RPM) is a healthcare technology that allows patients to collect and transmit health data to their healthcare providers from their homes or other non-traditional healthcare settings.

HOW DOES REMOTE PATIENT MONITORING WORK? 

• Patients use medical devices, such as blood pressure monitors, glucose meters, or weight scales, to collect health data.

• The data is transmitted wirelessly to the healthcare provider through a secure network.

• Healthcare providers review the data and use it to make informed decisions about the patient’s care.

The benefits of remote patient monitoring are improved patient engagement and self-management, reduced hospitalizations and readmissions, early detection of health problems, and cost-effective healthcare.

 

WHO IS CLOVIS RPM, LLC? 

Clovis RPM specializes in remote patient monitoring devices and services necessary to bill Medicare and other insurance providers for patients with chronic or acute conditions that require ongoing supervision.  The equipment Clovis supplies to the patient can transmit through a personal cell phone, Smart Gateway at the patient’s home, or our new DR Watch to the health cloud.

Our all-inclusive package is a comprehensive program that includes everything needed for Remote Patient Monitoring. It includes 20 minutes of registered nursing time required for the prescribing physician needed to bill for his/her professional fees. Clovis handles everything for the medical practice and patient including eligibility, educational support to the patient in setting up the device(s), required use of the devices, recording the data, transmitting the data to the health cloud, and technical support for any issues that may arise related to its products, transferring the data to the physician or medical practice, and notifying the patient and/or provider of any alarming data captured during the monitoring program.  The intended result is to provide better disease and illness management and improve patient care and compliance without increasing the workload on the medical practice, its employees, mid-levels and physicians.

What are the requirements needed to perform and bill for remote patient monitoring services?

Patient Responsibilities: 

• Patient’s must have an acute or chronic condition that requires ongoing monitoring to ensure effective management and to prevent complications or readmissions.

• Conditions include:  Diabetes, hypertension, heart failure, COPD and acute conditions such as asthma, pneumonia, and sepsis.

• The patient must provide explicit consent to have their health data collected and shared with the care team.  The patient should be informed and educated by their physician about the need, benefits and intended outcome of having their health monitored.

• The patient needs a medical device (e.g., blood pressure monitor, glucometer, pulse oximeter that is FDA-approved for medical use and can collect and digitally upload health data.

• A reliable internet connection is necessary to transmit the collected data from the device to the healthcare provider’s platform.

• The patient should receive adequate training on how to use the device and understand the monitoring process to ensure compliance and effective participation.

 

Healthcare Provider/Medical Practice Responsibilities: 

• A physician’s order is required to initiate RPM services, specifying the medical necessity and the conditions to be monitored.

• There must be an existing provider-patient relationship before RPM services can be billed.

• For Medicare and insurance billing, data must be collected for at least 16 days out of 30 days.

• A system is needed to receive, visualize, trend, and alert the care team about the collected patient data.

• The program requires dedicated healthcare professionals to manage the data, intervene when necessary, and collaborate on the patient’s care.

• Healthcare providers must adhere to regulations like HIPAA to ensure patient privacy and data security.  

 

WHAT ARE THE BENEFITS OF CONTRACTING AND WORKING WITH CLOVIS RPM, LLC? 

There is no upfront cost for equipment or services provided to the patient or the practice.  Before a patient starts the program, or receives any equipment or devices, Clovis will determine eligibility through the patient’s Medicare program or health insurance.

The physician or practice will have access to patient data collected to help improve the patient’s plan of care, enhance patient compliance, and ultimately lead to better patient outcomes.  The data will be uploaded by Clovis and its nurses directly to the practices’ EMR/EHR systems. Studies have confirmed that remote patient monitoring has reduced hospitalization events up to 30 percent. Clovis handles all the back-office work needed to implement and execute the remote patient monitoring program for the physician and practice.

In addition to providing information that will allow the physician or practice to provide a higher level of quality care, Clovis assists the practice and/or physicians in creating an additional revenue stream for the practice.

WHAT CAN THE PHYSICIAN OR PRACTICE EXPECT TO COLLECT BY IMPLEMENTING REMOTE PATIENT MONITORING FOR THE PATIENTS THAT QUALIFY? 

Depending on the program selected, the physician and/or practice can expect to earn net revenue between $40.00 per month per patient for the most basic service and up to $145.00 per month per patient for patients who require additional services related to their condition(s).  For the higher reimbursement, the actual physician will be required to perform some additional one-on-one interaction with the patient through video conferencing or telehealth.

HOW DOES CLOVIS RPM, LLC BILL AND COLLECT FOR ITS SERVICES? 

Because CLOVIS RPM, LLC is new to the market, it is not credentialled with many of the major health insurance carriers.  CLOVIS RPM, LLC has a dedicated team working to get its products and services approved by all major health insurance and Medicare programs.

In the interim, Clovis RPM, LLC is credentialled with some Medicare Programs that allows it to bill directly for a monthly device rental fee and the technical component of remote patient monitoring services.  For patients that qualify with Clovis RPM, LLC under this program, Clovis RPM, LLC will bill Medicare directly under its NPI number, and then work with the physician and/or practice’s billing company so the physician can bill and collect the professional fees associated with these services. Clovis RPM, LLC will provide all necessary documentation for the physician’s or practice’s biller to submit to the Medicare Clearing House(s) for reimbursement.  Payment for professional fees in this program will be made directly to the physician and/or practice. The device rental and technical component will be paid directly to Clovis RPM, LLC for its services.

 

WHAT IF CLOVIS RPM, LLC IS NOT CREDENTIALLED AND CANNOT BILL DIRECT FOR THE DEVICE RENTAL AND TECHNICAL SERVICES? 

In this scenario, CLOVIS RPM, LLC offers the physician and/or practice an alternative program.  The physician or practice contracts with CLOVIS RPM, LLC to provide the equipment to the patient and provides all the remote patient monitoring services including the individualized nursing program, data collection, data transfer, and all supporting services needed to ensure the physician and/or medical practice can properly bill and collect from the insurances it is credentialled and authorized to bill.

The physician and/or practice bills all the services under its NPI number.  Clovis in turn will invoice the physician and/or practice a fee of $60.00 per patient per month on the last day of each month.  That invoice will not become due for an additional thirty (30) days to ensure the practice has time to bill and collect its fees. We only ask that the practice or physician place a credit card on file that can be debited on the due date listed on the invoice.   This arrangement is intended to reduce or eliminate the financial burden of paying a contracted vendor, in this case CLOVIS RPM, LLC, upfront for devices and services, and to allow the clinic and/or physician to receive payment from Medicare or an insurance carrier.  As previously mentioned, CLOVIS RPM, LLC will provide all the documentation needed for the physician and/or practice’s biller to submit for reimbursement.

 

IS IT LEGAL FOR A PHYSICIAN AND/OR PRACTICE TO CONTRACT WITH A THIRD-PARTY VENDOR FOR REMOTE PATIENT MONITORING SERVICES AND REMOTE PATIENT MONITORING EQUIPMENT? 

Yes, it is legal for a doctor to contract out for remote patient monitoring (RPM) services, provided the third-party vendor complies with HIPAA through a business associate agreement, handles data and device requirements according to regulations, and the billing practitioner maintains general supervision.

Key requirements include getting patient consent, ensuring devices meet FDA definitions, and verifying that the contracted staff operates under the billing physician’s general supervision. Some Medicare plans allow outsourcing for some RPM services that don’t require physician-level knowledge, incentivizing providers to adopt RPM while managing workload.

WHAT IS NEEDED FROM THE PHYSICIAN AND/OR PRACTICE TO START A REMOTE PATIENT MONITORING PROGRAM WITH CLOVIS RPM, LLC? 

Clovis RPM, LLC, at its expense, has worked with its health care attorneys to create a complaint Business Associates Agreement and contracts which allows the parties to exchange HIPPA protected patient information.  The physician and/or practice will need to execute a Business Associates Agreement, a contract for Remote Patient Monitoring Services and Equipment, educate patient on need of the services, educate patient on importance of compliance, assist in obtaining consent from the patient to accept these services, provide needed patient data with their consent to perform tasks of confirming eligibility, provide description of patient’s qualifying condition and corresponding ICD 10 diagnosis codes.             

 

Documents and Information Needed: 

• Business Associates Agreement between practice and/or physician.

• Contract between Clovis RPM, LLC and the physician and/or practice.

• Credit Card on File with Clovis RPM, LLC.

• Consent form on practice letterhead signed by patient agreeing to remote patient monitoring services and data collection, acknowledgement of discussion with the treating physician about the services being provided, the importance of patient compliance, and permission from patient for Clovis RPM, LLC to contact patient for onboarding, set up, and proper use of device(s).

• Patient’s demographics, including date of birth, address, phone number(s).

• Insurance information of the patient, along with the name of the insurance carrier, group number, and member number.

• Description of qualifying condition and corresponding ICD 10 Diagnosis Codes

• Contact information for physician and/or practices biller or billing company.

• Prescription from physician for these services.

• Authorization from physician and/or practice to contact the responsible payor, whether Medicare or private health insurance carrier, for eligibility and/or pre-authorization confirmation.

• Access to EMR/EHR to upload all data and reports of the patient.

• Contact person for the physician and/or medical practice in the event abnormal data is reported and needs immediate attention.

272 Q&A About Clovis RPM Services