Primary care physicians have faced increasing pressure in recent years to grow revenues and retain patients, and for many the COVID-19 pandemic was a breaking point. For clinics ill-equipped for the subsequent explosion in telehealth visits, fewer in-person visits led to stark drops in revenue, with researchers estimating primary care losses of $15.1 billion due to decreased visits. While some clinics have begun to recover financially, nearly a third (32%) of the providers polled in a September 2021 survey reported they had not.

In the midst of rising operating costs and faced with disruptions from a seemingly ever-growing admin burden and shockingly high healthcare employee burnout, clinics need to be strategic about where they invest their resources to bring in revenue both directly via more visits and reimbursement and indirectly via more referrals and better, longer-lasting relationships with patients. 

While no silver bullet, remote patient monitoring and chronic care management (RPM/CCM) services can go a long way in each of these areas. By deploying RPM and/or CCM at your clinic, you can not only offer much-needed support to some of your most vulnerable patients, but also enjoy a steady stream of revenue, free up clinic capacity and build deeper connections with patients. And with the help of a third-party CCM/RPM provider, you can set up and run these programs while adding hardly any work to your staff’s plate.

What are CCM and RPM?

Before we dive into the potential benefits of these services, let’s lay out what we mean by CCM/RPM. 

CCM is supplemental care designed to help patients with chronic health conditions better maintain their health long term and avoid negative health outcomes. Chronic conditions are defined by the Centers for Medicare and Medicaid Studies (CMS) as illnesses expected to last at least 12 months (or until the death of the patient) that put patients at significant risk of death, acute exacerbation/decompensation or functional decline. This includes conditions like diabetes, high blood pressure, COPD and more.

CCM typically covers patients with two or more chronic conditions who have a continuous relationship with their care team and sees providers offering support via care plan formation, remote communication or coaching (typically via phone), care coordination between providers, prescription management and more.

Meanwhile, RPM is often used as a supplement to CCM and sees providers collecting physiologic data from health monitoring devices – such as blood glucose monitors, blood pressure monitors, scales and pulse oximeters – in order to track and manage conditions remotely. Providers give qualifying patients devices to use at home and data is transmitted electronically. To qualify for reimbursement, RPM data must be collected in this way and cannot be self-reported by the patient or collected with their personal devices.

Now that we’re clear on the definition of CCM/RPM, here are five key ways CCM and RPM can help you increase revenue at your medical practice.

1. Revenue via reimbursement

The most obvious—but still surprisingly overlooked—benefit of CCM/RPM services for primary care clinics in terms of revenue is that they allow you to claim reimbursement from Medicare on an ongoing basis. Due to the improved health outcomes that result from extra follow up and monitoring for patients with chronic diseases, Medicare uses CPT codes for RPM and CCM to incentivize providers to offer supplemental care beyond traditional clinic visits. 

You can claim reimbursement for initial setup and education on vitals monitoring devices as well as time spent discussing vitals readings with patients, offering coaching on healthy habits, coordinating care and more. 

Many of these CPT codes allow you to claim reimbursement not only if the services were offered by the physician themselves, but also if handled by clinical staff under the supervision and direction of a physician or non-physician practitioner. This means that even if you don’t have the time to handle all aspects of CCM services yourself, you may still be able to bill for services offered by eligible staff, as long as CCM/RPM are recommended as part of a patient’s care plan.

Additionally, reimbursement rates for many CCM services increased in 2022 as part of the Medicare Physician Fee Schedule Final Rule, with individual CPT code reimbursements rising as much as 51% from 2021. While reimbursement for RPM dropped a bit in 2022, these services make a great pair with CCM for many patients. Doing so would allow you to claim reimbursement in two categories of care while also maximizing patient touch points and guidance.

Here’s a quick look at some of the most popular Medicare CPT codes for RPM and CCM:

CPT Code Covered service CCM / RPM Reimbursement rate*
99490 20-minute block of care by provider or qualified professional CCM $62 per patient, billable monthly
99491 30-minute block of care by provider or qualified professional CCM $74 per patient, billable monthly
99493 Additional 20-minute block of care CCM $47 per patient, billed as needed (up to 2 times / month)
99453 Initial remote monitoring device setup and education RPM $21 per patient, billed once
99454 Ongoing vitals monitoring via devices (data transmitted electronically)  RPM $49 per patient, billable monthly (as long as RPM data is sent on at least 16 days out of each 30-day period)
99457 20 minutes of clinical follow-up on RPM data  RPM $49 per patient, billable monthly
99458 Additional 20 minutes of clinical follow-up RPM $40 per patient, billable up to 2 times / month

As you can see, if your primary care clinic has a large Medicare patient population, you stand to earn significant additional recurring revenue by offering a CCM/RPM program. 

For the sake of simplicity, let’s say you had 100 eligible Medicare patients participate in your CCM program, with each receiving 20 minutes of eligible care management services per month as defined by CPT 99490. Given the $62 reimbursement rate, you could bring in over $70,000 in additional annual revenue via CCM alone.

For a full breakdown of these and other CCM/RPM CPT codes, see our 2022 guide to CCM and RPM CPT Codes.

2. Increased clinic capacity and efficiency

Along with direct revenue via Medicare reimbursement, deploying a virtual CCM/RPM program at your clinic could help you to free up additional space for in-person appointments, allowing you to bring in new patients or see existing patients more frequently. 

With the help of a dedicated virtual RPM/CCM program, you’ll can set aside less time for routine in-person chronic care check-ins or to review patient data from a notebook or their own vitals monitoring device. You’ll also have much more visibility into patient progress and a chance for more regular communication, which could help avoid redundant follow-up visits with non-compliant chronic care patients—appointments which often end with physicians repeating the same advice they did in the last visit weeks or months earlier and lead to few health changes.

Missed appointments can also be a big source of frustration for primary care doctors, resulting in lost revenue from the individual patient as well as opportunity cost via wasted prep time, unoptimized schedules and replacement appointments. 

CCM can help here as well. CCM services encompass a wide range of activities, including not only health support via chronic disease education or prescription reviews, but care coordination activities like scheduling appointments and offering reminders, updating medical records (for instance, if a patient was in the hospital), or arranging transportation to clinic visits. 

All of these activities are not only eligible on their own for reimbursement as part of CPT 99490 or 99491, but they also can help your clinic run more efficiently.

The caveat is that since CCM/RPM services require ongoing management, paperwork and patient communications, you may lack the staffing resources needed to handle both traditional in-person clinic visits and virtual CCM/RPM duties. This is where a third-party managed CCM/RPM solution can be a big help. 

A third-party CCM/RPM company can handle much of the heavy lifting that would otherwise fall to clinic staff: Sourcing and providing patients with training on vitals monitoring devices, collecting vitals data electronically (required for RPM reimbursement by CPT 99454), reviewing data and offering feedback to patients in line with their physicians care plan, as well as offering coaching on building better habits, sticking to medication and coordinating care. 

Medicare considers these companies’ in-house clinicians under the primary care doctor’s supervision, so you can claim reimbursement on RPM/CCM services offered to eligible patients.  Some companies even offer help with the reimbursement process itself, further lightening your admin burden. 

In many cases, third-party RPM/CCM companies won’t even charge you any money upfront to set up and manage these programs. Instead, they’ll take a post-reimbursement fee. While keeping all reimbursement revenue for yourself would be ideal, this is a terrific compromise for clinics that don’t have the resources to run an RPM/CCM program themselves. 

Ready to get started with CCM/RPM without adding a ton of work to your staff’s plate? See how myNurse can help you deploy a CCM/RPM program and open a new revenue stream via Medicare reimbursement, all at no upfront cost. Contact us to learn more.

3. Higher patient satisfaction and retention

Another key benefit of deploying CCM/RPM services at your clinic is the connection it helps physicians and staff form with patients and the resulting patient loyalty, satisfaction and retention. 

CCM/RPM services give patients access to a dedicated care team that’s invested in helping them improve their health and manage their chronic conditions while also making it easier to get feedback, ask questions and schedule appointments with their primary care doctor and specialists. This helps ensure each patient’s physical, mental, and social needs are addressed in a timely manner and gives them a level of personal attention that’s hard to match in a quick visit once every couple of months. 

Physicians and clinical staff also have the information they need to respond proactively to acute symptoms, medication side effects, social and financial health barriers and more, earning even more patient trust and appreciation. Monitoring and regular touchpoints between clinicians and high-risk patients can also provide extra peace of mind for caregivers or family members.

Taken together, these patient-centered services can deepen the patient-provider relationship and make people feel special and taken care of. What more can you ask for if you’re looking for ways to increase patient satisfaction and retention (and the increased revenue that comes with them)? 

Bottom line: A win-win for patients and providers

Though the prospect of setting up a CCM/RPM program from scratch can be intimidating, the benefits for both patients and providers are innumerable. Your highest-risk patients get the care and support they need (often at little to no cost to them with qualifying Medicare supplemental coverage) and you can enjoy a steady new revenue stream, free up clinic capacity for in-person visits and boost patient satisfaction. 

* Note: This information is not a guarantee that specific services will be reimbursed. All reimbursement amounts are approximate, non-facility reimbursement amounts for 2022. Clinics should ensure that claims are submitted in accordance with their revenue cycle team’s processes and approval.
Waleed Mohsen

Author Waleed Mohsen

Waleed Mohsen is the co-founder and CEO of mynurse.ai. He has been named a UCSF Rosenman Innovator and has over 10 years of experience working with leaders of hospitals and medical institutions in his business development roles at Siemens and Cisco.

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