Category: RPM

CMS Promoting RPM by Adding New Codes in 2026

by hws2022, posted in RPM

CMS Promoting RPM by Adding New Codes in 2026

RPM adoption remains limited: Only 30% of U.S. physicians used remote patient monitoring in 2022 (AMA Digital Health Study).

CMS introduced two new RPM codes for 2026, aiming to make RPM more accessible, billable, and clinically valuable for both practitioners and patients.

Why RPM Lagged in Real Practice

1. Reimbursement uncertainty & complex billing: Strict transmission-day minimums, evolving CPT rules, and heavy documentation made adoption difficult.

2. High upfront costs & tech barriers: FDA-cleared devices, HIPAA-secure platforms, and EHR integration were expensive and challenging for small clinics.

3. Workflow burden & staffing constraints: Continuous data review, patient check-ins, and documentation required more staff than many practices could allocate.

New CMS Codes (Effective 2026)

      • CPT 99445 (~$47): Covers 2–15 days of short-term RPM data in a 30-day period.
      • CPT 99470 (~$26): Covers 10–19 minutes of monthly RPM management time and requires at least one real-time patient interaction.

    • Impact After Implementation of the New RPM Codes 

      • Lower entry threshold for small practices.
      • Flexible billing aligned with real-world clinical workflows
      • Expanded access across primary care, cardiology, endocrinology, nephrology, geriatrics

Real-World Outcomes & ROI Post CMS Code Implementation

This is a 1,000-Patient Chronic-Care Panel through which one can understand the care and ROI. 
      • Patient Panel: 300 CHF, 350 diabetes, 350 hypertension
      • Clinical impact:
          • ~20% reduction in CHF hospitalizations (PMC10424885)
          • Improved diabetes & hypertension control (PubMed39974005)
          • Increased patient engagement via real-time feedback & monthly interactions
      • Financial & operational impact (current codes):
          • Program cost: ~$500/patient/year
          • Revenue: ~$700K/year
          • Savings from avoided acute events: $400K–$600K
          • ROI: ~20–40%, including AI-driven efficiency
      • Projected impact with 2026 codes:
          • Revenue: ~$900K–$1.1M/year
          • ROI: ~300–500%
          • Sustained improvements in chronic-disease management.
          • Lower hospitalizations, better patient adherence
Takeaway: With CMS’s 2026 updates, RPM not only increases revenue but directly enhances patient health and quality of care, making it a clinically and economically valuable strategy. Contact: contact@medicalofficeforce.com
2026 Remote Patient Monitoring CPT Code by CMS with estimated ROI, projected 3x–5x return and major clinical quality improvements.

Frequently Asked Questions (FAQs)

Q. What is the reimbursement for CPT 99445?

A. The reimbursement for CPT 99445 is approximately $47.

Q. What is the reimbursement for CPT 99470?

A. The reimbursement for CPT 99470 is approximately $26.

Q. When will the new RPM CPT codes take effect?

A. The new Remote Patient Monitoring (RPM) CPT codes take effect on January 1, 2026, as part of the annual 2026 CPT code set updates by CMS.

References:

How to Use Remote Patient Monitoring for Obesity & Weight Loss

by hws2022, posted in RPM

How to Use Remote Patient Monitoring for Obesity & Weight Loss

Obesity affects over 42% of U.S. adults, increasing the risk of diabetes, heart disease, and other chronic conditions. Traditional care often loses momentum between visits, but Remote Patient Monitoring (RPM) helps bridge that gap. (CDC)

Why physicians often struggle to achieve consistent patient outcomes

      • Time constraints: Typical visits last 10 to 15 minutes, leaving limited scope to explore dietary patterns, sleep health, and psychological triggers in depth.
      • Biological complexity: Obesity is often treated as a lifestyle issue rather than a neurohormonal and metabolic condition that requires medical intervention.
      • Irregular follow-up: Without structured continuity, patients lose motivation, and small lapses quickly reverse progress.
      • Underuse of technology: Many practices still rely solely on in-person check-ins, missing opportunities for remote monitoring, automated feedback, and patient accountability.

Building a more effective clinical model for obesity care

      • Begin with a structured baseline evaluation.
        Go beyond BMI to assess waist circumference, visceral fat indicators, sleep patterns, mental health, medication-related weight gain, and past weight-loss attempts.
      • Set realistic, collaborative goals.
        Define measurable milestones that feel achievable for the patient, for instance, a 5 percent weight reduction in three months or a daily step target of 7,000.
      • Combine behavioral coaching and evidence-based therapy.
        Motivational interviewing, meal structure planning, and small daily changes often outperform drastic diet restrictions. When appropriate, incorporate FDA-approved anti-obesity medications.
      • Address underlying sleep and mental health issues.
        Depression, insomnia, stress eating, and obstructive sleep apnea all contribute to metabolic dysregulation.
      • Maintain consistent follow-up frequency.
        Patients are most successful when they receive regular reinforcement, biweekly touchpoints initially, tapering to monthly check-ins once weight stabilizes.
      • Early feedback enables timely course correction before motivation declines.

How Remote Patient Monitoring changes the trajectory of weight management

RPM allows physicians to:

      • Track real-time changes in weight, blood pressure, and activity levels. 
      • Provide structured weekly feedback that reinforces accountability. 
      • Identify plateau phases early and modify care plans proactively. 
      • Increase adherence through consistent digital touchpoints rather than waiting for the next appointment

Proven results by RPM

      • Digital monitoring plus feedback: Tracking weight with real-time coaching improves adherence and long-term outcomes (PMC4380831). 
      • Behavioral changes: Continuous data keeps patients accountable between visits. 
      • Durable impact: Clinically supervised digital programs support lasting weight maintenance (CDC Adult Obesity Facts).

Current CPT codes such as 99453, 99454, 99457, and 99458 support reimbursement for setup, device transmission, and interactive communication, helping practices sustain high-quality, continuous care. CMS RPM guidance.

The role of Medical Office Force in supporting clinical implementation

Medical Office Force supports practices in building effective RPM programs, compliant billing, and real-time data visibility. 

Our RCM and clinical support services are designed to reduce administrative load, help improve the accuracy of documentation, and make sure patients receive consistent, connected care.

References

The Future of Remote Patient Monitoring (RPM)

The Future of Remote Patient Monitoring (RPM)

by hws2022, posted in RPM
The Future of Remote Patient Monitoring (RPM)

The Future of Remote Patient Monitoring (RPM)

Remote Patient Monitoring (RPM) is revolutionizing the way care is provided. Doctors and care teams can keep tabs on patients’ health from anywhere, including at home. By using devices like wearables, blood pressure cuffs, or glucose monitors, critical health information is reported directly to providers. This allows patients to remain in touch with care without always having to visit a clinic.

RPM is being used already in the case of diabetes, hypertension, and heart failure. So what’s next, then? These are some of the directions that the future of RPM will take.

The Future of Remote Patient Monitoring (RPM)

Wearables become smaller, more intelligent, and easier to use. Someday devices will be able to track vital signs as well as issue preemptive signs of conditions like an erratic heart rhythm, sleeping disorders, or changes in breathing. Cleveland Clinic notes that when devices become part of systematized care systems, they can contribute to more rapid and more competent responses from the provider (Cleveland Clinic).

AI and Machine Learning Integration

RPM produces so much information daily. Doctors and nurses can utilize artificial intelligence (AI) and machine learning to sort through this data and discover patterns. For example, the program can highlight the patients that need care within the shortest possible time. Medical articles suggest that the application of RPM with predictive analytics can contribute to timely intervention (PMC).

Increased Patient Engagement

If patients see their health data often, they are more likely to become more active in their care. RPM devices remind individuals to follow their plans of therapy and keep in touch with their care providers. Studies showed that telemonitoring strengthens communication and keeps patients more engaged with the care of their health (PMC).

Enhanced Data Security

An issue with RPM is the protection of patient information. The more devices that are implemented, the more important it is to safeguard private health information. The Agency for Healthcare Research and Quality points out that the use of safe systems and stringent measures of privacy is required in order to use RPM safely (AHRQ). The future programs will hopefully implement better encryption, more stringent rules, and better protection in order to ensure health information remains protected.

Telehealth and RPM Convergence

RPM and telehealth increasingly coexist. Medicare also reimburses RPM billing and so providers can remotely monitor patients and communicate with patients through virtual visit (CMS). The future holds that the combined solution will become commonplace, keeping home care more convenient for patients.

Expansion in Chronic Disease Management

Today, RPM is mainly used in chronic illnesses like diabetes, hypertension, and heart failure. However, evidence suggests that the use is spreading in other areas like in oncology care, in psychiatrics, and in post-surgical recovery. Mayo Clinic reported some positives with RPM in lung transplant patients and in post-COVID-19 recovery protocols (Mayo Clinic). The suggestion is that the use of RPM will spread in many other areas of care in the future.

Insurance and Reimbursement Policies

Reimbursement will be critical in the future of RPM. Medicare created codes to bill for RPM services, and private payers are following suit (CMS). Broader clear and consistent coverage will allow more providers to use RPM as standard care.

Global Adoption and Localization

RPM is picking up in the U.S. as well as internationally. Each place will use it in its own manner, based on the local healthcare system, connectivity, and needs of the patients. Where there is restricted access to hospitals, RPM can bring care within the reach of more individuals.

How Medical Office Force Supports Healthcare Providers

As the healthcare landscape continues to evolve, adopting tools like RPM can benefit practices in improving patient outcomes and efficiency. Medical Office Force provides support services to healthcare organizations, including medical billing, coding, and practice management services. Our experience can benefit providers in working with the administrative and compliance aspect of RPM reimbursement so that practices can focus on the care of the patient while remaining compliant with the requirements of CMS.

Conclusion

The future of Remote Patient Monitoring is linked closely with policies, technology, and the needs of patients. AI-powered insights, and better integration with telehealth will continue the march toward making RPM more practical in everyday care. Success of the field, though, will depend upon better protections of data as well as equal policies of reimbursement.

For healthcare professionals, adopting RPM involves new means of empowering patients while being adaptable with the changing care strategies. At Medical Office Force, we facilitate practicing with billing, compliance, and administrative services so that they may focus on care for the patients while adapting with new healthcare solutions.

References

RPM Changes 2026: What Primary Care Physicians Need to Know

by Chris Dillon, posted in RPM

RPM Changes 2026: What Primary Care Physicians Need to Know — with Medical Office Force by Your Side

At Medical Office Force, we don’t just follow Centers for Medicare & Medicaid Services (CMS) updates; we live and breathe them, translating regulatory changes into real-world solutions for primary care practices across the country. With the 2026 Medicare Fee Schedule (PFS) introducing new Remote Patient Monitoring (RPM) updates, it’s time for primary care physicians to lean in, prepare, and seize the opportunities ahead.

At Medical Office Force, we help primary care providers to streamline operations, boost confidence, and improve profitability.

Why These 2026 CMS Updates Matter

If you’ve been offering RPM, Chronic Care Management (CCM), or any form of office-based care, these updates could directly impact how you’ll be reimbursed and how your team operates daily. But don’t worry, we’ve broken down the most critical updates so your practice can be ready to thrive, not just survive.

1. New RPM Codes = More Billing Flexibility

 

Code

Service

Time/Days Requirement

Reimbursement Estimate

99454

Device supply & data transmission (16–30 days)

16–30 days

Standard Rate

99445
(NEW)

Device supply & data transmission (2–15 days)

2–15 days

Same as 99454

99457

RPM management time (20+ minutes)

≥ 20 minutes

Standard Rate

99470
(NEW)

RPM management time (10–19 minutes)

10–19 minutes

Roughly 50% of 99457

What’s changing?

1. A new RPM device code (99445) for 2–15 days of monitoring (currently, 99454 requires 16 days).

2. A new code (99470) for 10–19 minutes of clinical RPM time, ideal when the time falls short of the full 99457 20-minute threshold.

What does this mean for you? You may be able to bill for the real care you’re already delivering,  those quick follow-ups, episodic checks, or short-term device monitoring after discharge.

What you can do now:

1. Review your current RPM caseload: Who might benefit from short-term monitoring?

2. Audit your care team’s time logs; many short but valuable touchpoints go unbilled.

3. Talk to your EHR or billing provider (or call us!) about getting ready for these new codes.

How Medical Office Force helps: We’ve already helped dozens of practices prepare for these coding shifts by streamlining documentation and automating time tracking for maximum RPM reimbursement.

2. CCM Isn’t Changing, But That’s No Reason to Get Comfortable

CCM codes like 99490 and 99439 aren’t going anywhere in 2026. But here’s the thing: many practices think they’re doing CCM right, but they’re still leaving money on the table.

What you can do now:

1. Tighten your documentation: Does it fully reflect the time and complexity involved?

2. Educate patients: Many don’t realize how valuable this monthly touchpoint is.

3. Check your billing logs: Are you capturing every minute you’re allowed?

Our Tip: We often find that practices under-document time or skip secondary codes like 99439. Our team can run a free consultation to make sure you’re maximizing what’s already on the books.

3. Office-Based Providers Get a Reimbursement Boost

In a welcome move, Centers for Medicare & Medicaid Services (CMS) is increasing reimbursement by +4% for services delivered in non-facility settings, a potential win for independent primary care physicians.

What this could mean: If you own or lease your office space and deliver care outside of a hospital or facility, you could see improved margins on certain services.

How to prepare:

1. Consider bringing in more diagnostics (like EKGs, echos) in-house.

2. Evaluate your service mix. Are there underutilized procedures you can expand?

3. Think ahead about marketing your “convenient, full-service” primary care.

Let us guide you: From analyzing service profitability to helping you negotiate with payers, we’ve supported independent clinics across the U.S. as they grow their in-house offerings.

4. Time-Based Coding Is the Future, Track Everything

Centers for Medicare & Medicaid Services (CMS) isn’t making major E/M changes for 2026, but the focus on time-based coding and chronic condition care continues.

Why this matters:  RPM, CCM, and E/M visits may overlap and when they do, you’ll need to track and report accurately.

Action steps:

1. Start tracking all care team time now (yes, even the 5-minute calls!).

2. Retrain your staff on the difference between 99457 vs 99458, and how time stacks across codes.

3. Use care coordination codes wherever they apply (e.g., TCM, PCM, BHI).

Medical Office Force makes this easy: Our proprietary documentation templates and workflows guide your team on what to record, when, and how, helping you stay compliant and profitable.

5. Speak Up, CMS Wants to Hear From You

The rule’s comment period closed on September 12, 2025. This is your chance to influence how final rules take shape.

Primary care physicians can advocate for:

1. Better pay for the care you’re already delivering

2. Less documentation hassle

3. Support for chronic care that’s actually sustainable

How to take action:

1. Join efforts through AAFP, ACP, or your local medical society.

2. Follow CMS newsletters and updates, or just subscribe to Medical Office Force’s curated update list.

3. Prepare your internal team to pivot billing practices early in 2026.

These updates prove one thing: Centers for Medicare & Medicaid Services (CMS) is finally catching up to the realities of primary care. But with change comes complexity, and you’ve got enough on your plate already.

Frequently Asked Questions (FAQs)

Centers for Medicare & Medicaid Services (CMS) has proposed two new CPT codes for 2026:

1. 99445 for device supply and data transmission when a patient provides 2–15 days of data in a 30-day period.

2. 99470 for 10–20 minutes of RPM management time, offering more billing flexibility for shorter interactions.

Centers for Medicare & Medicaid Services (CMS) has proposed two new CPT codes for 2026:

1. 99445 for device supply and data transmission when a patient provides 2–15 days of data in a 30-day period.

2. 99470 for 10–20 minutes of RPM management time, offering more billing flexibility for shorter interactions.

Yes. Existing codes such as 99454, 99457, and 99458 remain valid in 2026. The new codes are additions, not replacements, allowing providers more flexibility in RPM billing.

1. 99454 is for patients who transmit 16–30 days of RPM data in a 30-day period.

2. 99445 is for cases where only 2–15 days of data are transmitted—previously unbillable under 99454.

Use 99470 when the RPM management time is between 10–20 minutes, which doesn’t meet the full 20-minute threshold required for 99457.

RPM services can be billed by physicians and certain non-physician practitioners (NPPs) like nurse practitioners, as long as the services meet Medicare requirements for medical necessity and supervision.

CMS introduced these codes to offer greater billing flexibility, improve patient compliance, and reflect real-world usage where patients may not transmit data every day or require shorter management time.

CMS sets the standard for Medicare, but many commercial insurers follow CMS guidance. However, coverage and adoption timelines can vary—check with individual payers.

Yes. The 16-day rule still applies to 99454. If fewer than 16 days of data are collected, you would use 99445 instead (if finalized).

If finalized, the new codes will become effective January 1, 2026, as part of the CY 2026 Medicare Physician Fee Schedule.

To understand the national adoption challenges, clinical outcomes and ROI projection behind CMS’s 2026 RPM updates, read our related blog – CMS Promoting RPM by Adding New Codes in 2026


At Medical Office Force, we’re here to walk alongside you,  not just as a service provider, but as your compliance partner, your billing expert, and your behind-the-scenes team.

So, what’s next? Let’s talk. Whether you want a free audit, a walkthrough of the new codes, or just a conversation about how your practice can adapt, we’re ready when you are.

Contact Medical Office Force today and let’s build a smarter future for your practice.

Why Every Practice Needs Remote Patient Monitoring in 2025

by hws2022, posted in RPM

How RPM Is Reshaping Patient Care and Provider Revenue

In 2025, one thing is clear: healthcare is no longer confined to the four walls of a clinic. As technology evolves and patient needs become more complex, healthcare providers must find new ways to offer timely, effective, and efficient care. Remote Patient Monitoring (RPM) has emerged as a game-changing solution, not only improving patient outcomes but also helping providers stay compliant and profitable in a value-based care landscape.

At Medical Office Force, we specialize in helping clinics, group practices, and solo physicians integrate fully compliant RPM programs. With years of domain expertise and a deep understanding of Medicare billing, chronic care delivery, and digital health workflows, we are your go-to partner for scaling RPM with confidence.

Let’s dive into why every practice should prioritize Remote Patient Monitoring in 2025, and how we can help you do it right.

What Is Remote Patient Monitoring?

Remote Patient Monitoring (RPM) is the use of connected health technologies, such as blood pressure cuffs, pulse oximeters, glucometers, and weight scales, to collect patient health data from home or non-clinical environments. This data is securely transmitted to healthcare providers for real-time review, alerts, and interventions.

RPM is particularly useful for managing chronic conditions such as:

1. Hypertension

2. Diabetes

3. Congestive Heart Failure (CHF)

4. Chronic Obstructive Pulmonary Disease (COPD)

5. Obesity and post-surgical care

Unlike traditional care models that depend on occasional in-person visits, RPM creates a continuous loop of communication, where clinicians stay informed between appointments.

RPM in 2025: Why Every Practice Is Making the Move

1. Shift Toward Value-Based Care

Insurance payers and Medicare are pushing for better health outcomes rather than just more services. RPM aligns perfectly with this model by focusing on early detection, chronic care management, and preventive intervention.

According to the Centers for Medicare & Medicaid Services (CMS), value-based care models are expected to cover nearly 70% of patients by 2025.

2. Increasing Chronic Disease Burden

Over 6 in 10 Americans live with at least one chronic condition. Managing these conditions in-person alone is no longer sustainable. RPM enables providers to:

1. Spot trends in vitals over time

2. Modify treatment plans faster

3. Prevent ER visits and hospital readmissions

https://www.cdc.gov/chronic-disease/

How RPM Benefits Patients

For patients, Remote Patient Monitoring is more than a convenience; it’s peace of mind.

1. No Commute, No Waiting Rooms: Especially beneficial for elderly, rural, or mobility-challenged patients

2. Real-Time Monitoring: Enables early detection of deterioration

3. Higher Engagement: Patients become active participants in managing their health

4. Better Clinical Outcomes: Timely interventions lead to improved health markers and fewer complications

How RPM Helps Physicians and Clinics Thrive

Beyond better care delivery, RPM also improves practice profitability. Here’s how:

1. Reimbursable CPT Codes

RPM services are reimbursable under Medicare Part B. These CPT codes include:

1. 99453 – Device setup and patient education

2. 99454 – Monthly device data collection and transmission

3. 99457 – 20+ minutes of care management and interaction

4. 99458 – Each additional 20 minutes of care


Depending on the payer and region, RPM programs can generate $120–$180 per patient per month, on top of existing revenue streams.

2. Improved Quality Metrics

Insurance payers track performance through quality scores tied to:

1. Blood pressure control

2. Diabetes A1C levels

3. Medication adherence

4. Readmission rates

RPM boosts these metrics, helping providers stay eligible for bonus payments, incentive programs, and better payer contracts.

3. Enhanced Patient Retention

When patients feel supported beyond the clinic, they’re more likely to stay loyal to their provider. RPM fosters a stronger patient-provider relationship by delivering care where patients need it most, at home.

Why Insurance Companies Support RPM

Private payers and government programs like Medicare and Medicaid are strongly backing RPM programs because:

1. It’s cost-effective – Catching problems early reduces ER visits and costly hospital stays

2. It improves patient outcomes – Healthier patients mean fewer claims

3. It fits value-based care mandates – Continuous monitoring leads to better chronic disease management

Insurers reward providers who can demonstrate these improvements through metrics. RPM is a direct path to doing just that.

Why Partner with the Medical Office Force?

At Medical Office Force, we’re not just vendors; we’re RPM implementation experts who support your clinical and administrative teams from start to finish. Here’s how we help:

1. Compliant Device Setup (Medicare-approved & pre-configured)

2. Patient Onboarding & Education

3. Monthly Data Monitoring & Alerts

4. Clinical Escalation Protocols

5. Full-Service Billing & Documentation Support

6. CCM + RPM Integration for Maximum Reimbursement


You don’t need a large staff or extra infrastructure. We streamline everything for you.

Real-World Impact: Outcomes That Matter

Thousands of practices across the U.S. have adopted RPM with tremendous success. They’ve witnessed:

1. Higher patient satisfaction scores

2. Reduced staff burnout due to automation

3. More predictable revenue from chronic patients

4. Compliance with evolving CMS mandates

Whether you’re running a small private practice or a multi-specialty clinic, RPM allows you to scale your care without scaling your team.

Ready to Transform Your Practice?

The future of healthcare is here, and it’s remote, real-time, and patient-centered.

RPM is not a “nice-to-have”; it’s becoming a standard of care.

With Medical Office Force by your side, you can be confident that your RPM journey will be seamless, compliant, and financially rewarding.

Let’s Get Started Today

Contact Medical Office Force to schedule your RPM discovery call.
 📞 +1 877-581-8810 
🌐 www.medicalofficeforce.com

Let’s bring care closer to your patients, and success closer to your practice.

checklist before starting CCM, RPM, or RTM in your practice

7 Things to Check Before Starting CCM, RPM, or RTM

by hws2022, posted in CCM, RPM, RTM
checklist before starting CCM, RPM, or RTM in your practice

7 Things to Check Before Starting CCM, RPM, or RTM in Your Practice

If you’re a doctor or clinic  owner looking to improve patient care and grow your revenue, programs like Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Remote Therapeutic Monitoring (RTM) are great opportunities. But before you jump in, there are a few things you should check to make sure you’re set up for success.

In this blog, we’ll explain 7 simple things you should check before starting any of these programs.

1. Do Your Patients Qualify?

Before anything else, you need to know which patients are eligible:

-> CCM: Patients must have 2 or more chronic conditions like diabetes, hypertension, or COPD.

-> RPM: Patients must need regular health monitoring using a device.

-> RTM: Great for patients with muscle, joint, or lung issues who need help following therapy plans using apps.

Why this matters: If a patient doesn’t qualify, Medicare or insurance may not pay you.

Look through your EHR and flag eligible patients. Most clinics already have dozens of patients who qualify but haven’t been enrolled yet.

2. Pick the Right Technology

The success of CCM, RPM, and RTM depends heavily on good technology. You need tools that:

1. They are easy for patients to use

2. Track and record time spent with patients

3. Send alerts when something needs attention

4. Are HIPAA compliant and secure

For RPM, make sure the device works automatically

For RTM, make sure the app helps patients report how they’re feeling and if they’re following therapy.

 Ask for a demo before you commit. A confusing system = frustrated staff and patients.

3. Train Your Team

Even with the best tech, your program won’t work if your team isn’t ready. Make sure to:

  • Train nurses and staff on what each program is
  • Show them how to track time, check data, and follow up
  • Explain what to do when a reading is too high or too low

Assign a CCM/RPM coordinator who can manage communication with patients and track monthly time.

4. Understand How You Get Paid

These programs pay you based on time and service. Here’s a rough idea:

-> CCM: Up to $110/month per patient

-> RPM: Up to $62/month per patient

-> RTM: Up to $93/month per patient

But you must:

1. Track time correctly (minimum of 20 minutes for CCM and 16 days of data for RPM)

2. Use the correct CPT billing codes

3. Get patient consent (usually verbal or written)

4. Compliant report generation monthly

Talk to your billing team or partner with a company that specializes in these services to avoid mistakes.

5. Help Patients Understand and Join

Many patients won’t know what CCM, RPM, or RTM means. Make it simple:

1. Explain that it’s a monthly check-in or health support service

2. Show them the device or app they’ll use

3. Let them know it helps keep them out of the hospital

Have a friendly team member walk them through it. Give them a printout or video that explains what they’re signing up for. 

Medical Office Force will help with onsite registration and patient education to keep your staff focused on your practice. 

For older patients, offer to help them set up the device or app during a visit.

6. Keep Good Records

If you’re billing Medicare, you need to keep records of:

1. Patient consent

2.Time spent on care coordination or reviewing data

3. Any actions you take (calls, alerts, medication reviews)

If you don’t have proof, you could fail an audit and have to return payments.

Use software that automatically tracks everything. It saves time and keeps you safe.

7. Decide: Do It Yourself or Get Help?

Running these programs in-house takes time, people, and tools. If you’re already busy, consider outsourcing to experts.

You can:

1. Do everything in-house

2. Get help from a CCM/RPM service provider (like Medical Office Force)

3. Start small and grow over time

 Outsourcing can help you launch faster with fewer headaches, especially at the start.

Final Thoughts

CCM, RPM, and RTM can truly change the way your practice works:

1. Better patient care

2. Fewer hospital visits

3. More monthly revenue

But success depends on proper planning.

1. Check patient eligibility

2. Choose smart tools

3. Train your team

4. Understand billing

5. Help patients onboard

6. Track everything

7. Know when to outsource

Need help getting started? Medical Office Force offers full support to help you launch, manage, and grow your remote care programs. Let’s work together to make it easy and profitable!

Visit www.medicalofficeforce.com to learn more.

Why Remote Patient Monitoring (RPM) Fails in the Healthcare System

by hws2022, posted in RPM

Why Remote Patient Monitoring (RPM) Fails in the Healthcare System

Remote Patient Monitoring (RPM) holds incredible promise for improving healthcare outcomes. It can help doctors manage chronic conditions, reduce hospital visits, and offer personalized care from a distance. The Centers for Medicare & Medicaid Services (CMS) even created billing codes to encourage its use. Yet, despite all this support, many RPM programs fail, or never reach their full potential.

Why is that?

In this blog, we’ll explore the common reasons why RPM fails in the healthcare system, and what practices can do to avoid these pitfalls.

What is RPM?

Remote Patient Monitoring is a form of telehealth that allows healthcare providers to track patients’ health data, like blood pressure, glucose levels, weight, or oxygen saturation, from home using digital devices. This data is then shared with providers through secure systems, allowing for timely interventions and better chronic care management.

 If you’re new to RPM, check out our post on why RPM leads the future of healthcare to understand its growing importance.

CMS began reimbursing RPM services in 2019 with the introduction of CPT codes such as:

  • 99453 (initial setup and patient education)
  • 99454 (supply of devices and data collection)
  • 99457 and 99458 (time spent on data review and patient interaction)

Despite these advancements, many RPM programs still struggle. 

Your RPM Program Doesn’t Have to Fail

Many healthcare practices find it difficult to get RPM off the ground—whether due to tech challenges, staffing, or reimbursement confusion. That’s why we offer dedicated Remote Patient Monitoring (RPM) services tailored to clinics just like yours, helping you launch and sustain an effective, compliant program.
Now, let’s break down the most common reasons RPM efforts fall short—and how to avoid them.

1. Patients Aren’t Using the Devices Consistently

One of the biggest reasons RPM fails is simple: patients stop using the devices.

Why does this happen?

  • Devices may be too difficult to use, especially for older adults.
  • There is little to no follow-up from care teams to ensure continued use.
  • Patients don’t understand how RPM helps them, so they lose interest.

What can be done?

Providers need to offer strong onboarding support, including live demos and easy-to-follow instructions. Regular check-ins can help boost adherence. Patients must feel like their data is making a difference.

2. Lack of Staff Training and Workflow Support

RPM can’t succeed without clinical staff who know how to use it. Many practices add RPM services without proper planning.

Common issues:

  • Staff are unclear on roles, who reviews the data, who calls the patient, and how often?
  • No one tracks time spent on RPM tasks, leading to missed reimbursements.
  • Data gets lost in emails or spreadsheets instead of flowing into the EHR.

Government relevance:

CMS mandates clear documentation for RPM billing. If staff aren’t trained on these guidelines, practices risk audits, denials, or non-compliance.

Solution:

Every clinic offering RPM should have a clear workflow in place, define responsibilities, and train all involved staff regularly.

3. Technology Problems and Poor Connectivity

Many RPM solutions fail due to unreliable devices, poor integration with medical records, or internet issues.

Common problems include:

  • Devices not syncing data correctly.
  • Platforms not integrating with electronic health records (EHRs).
  • Patients living in rural or low-income areas without stable internet access.

Government angle:

The Federal Communications Commission (FCC) has acknowledged the digital divide in healthcare. They fund initiatives like the Rural Health Care Program, but progress is slow.

What to do:

Choose devices with strong technical support and a track record of reliability. Make sure the platform is HIPAA-compliant and EHR-compatible.

4. Confusion Around Billing and Documentation

While CMS has provided RPM billing codes, many providers still don’t use them correctly, or at all.

Issues include:

  • Not meeting the 20-minute time requirement for 99457/99458.
  • Missing documentation for device delivery or patient interaction.
  • Failing to differentiate RPM from other telehealth services.

What CMS says:

CMS requires specific criteria for billing RPM services, including patient consent, device use for at least 16 days/month, and time-tracking logs.

Fix:

Use software that automatically tracks time spent on patient care and generates reports for billing. Partner with third-party billing experts if needed.

5. Lack of Reimbursement Knowledge for Medicare Advantage and Medicaid

While traditional Medicare covers RPM fairly well, rules vary for Medicare Advantage plans and state Medicaid programs.

Challenge:

  • Not all payers reimburse RPM the same way.
  • Practices assume all patients are covered, then face denials.

Example:

Some state Medicaid programs cover RPM only for specific conditions (like diabetes or hypertension), and some not at all.

Solution:

Verify benefits before starting RPM with a patient. Use clearinghouses or revenue cycle management tools to identify covered services.

6. Offering RPM to the Wrong Patient Populations

RPM works best for patients with chronic conditions, who require frequent monitoring.
Common mistake:

  • Offering RPM to young, healthy patients who don’t need ongoing tracking.
  • Not focusing on Medicare patients with chronic conditions, who are most likely to benefit and be covered.

CMS guidance:

Medicare’s Chronic Care Management (CCM) and RPM programs are designed to work hand-in-hand for patients with two or more chronic conditions.

Best practice:

Use data to identify your ideal RPM patients, those with high risk, frequent ER visits, or poorly managed chronic diseases.

7. Poor Communication with Patients

Even if everything else works well, RPM fails when communication breaks down.

How?

  • Patients don’t know what the readings mean.
  • They never hear from a provider after sending in their data.
  • They don’t feel engaged in their own care.

The result?

Patients stop using the device, or worse, they feel neglected and lose trust.

Fix:

Build RPM into your care model, not as a side program. Ensure patients receive feedback and feel part of their care team.

8. Compliance and Privacy Concerns

HIPAA compliance is a non-negotiable part of any healthcare technology.

Problems arise when:

  • RPM devices are not encrypted or properly secured.
  • Data is stored or transmitted without proper protections.

Why it matters:

A HIPAA breach can cost millions in fines and damage patient trust permanently.

What to do:

Work only with vendors who understand healthcare compliance. Make sure all systems are HIPAA-certified and security-tested.

How Medical Office Force Can Help

At Medical Office Force, we understand the unique challenges practices face with RPM. Our expert back-office teams can help you:

1. Identify ideal patients for RPM.

2. Manage device setup and tracking.

3. Ensure proper documentation for billing.

4. Navigate Medicare and Medicaid coverage rules.

5. Train your staff and integrate RPM into your workflows.

With the right support, RPM can be a powerful tool for better care—and better revenue.

Conclusion

RPM doesn’t fail because the idea is flawed. It fails because practices lack the resources, planning, and education to implement it correctly. With proper workflows, trained staff, engaged patients, and support from partners like Medical Office Force, your RPM program can thrive.

If you’re ready to take your RPM program to the next level, or you’re just getting started, reach out to us today.

10 Reasons to Outsource Your Medical Billing

by hws2022, posted in RPM
outsource medical billing

10 Reasons to Outsource Your Medical Billing

Outsourcing isn’t exactly a new idea, but it can feel like a bit of a gamble when it comes to medical billing. That’s mainly because medical billing and coding are closely linked, and if your service provider isn’t skilled at picking the right codes, you could end up with some pretty messy bills, leading to significant losses. However, outsourcing can be a smooth experience when done right, freeing you up to focus on your main business strategies. Here are some compelling reasons to consider outsourcing your medical billing:

1. Increased Control: A common myth is that outsourcing your medical billing means losing control over your business processes. In reality, many find they have a better grip on their billing and finances thanks to a trained and dedicated outsourced billing team. This enhanced control can lead to operational benefits that truly make outsourcing worthwhile.

2. Increased Revenues: Outsourcing medical billing can save companies a significant amount of time and money on salaries, office space, and the costs associated with purchasing, upgrading, and maintaining billing software. By cutting down on overhead costs and ensuring timely claim submissions, businesses can see a boost in revenues as reimbursements increase.

3. Better Safety: Handing over your billing processes to a third-party service provider is a safe move. Reputable outsourcing companies offer a transparent billing process, and most are HIPAA-compliant with secure medical billing practices to protect against hacking attempts. Companies need to know their data is kept confidential, and trusted outsourcing providers have the necessary security measures and infrastructure to ensure a safe environment for medical billing operations.

4. Changing Regulations: The landscape of medical billing is always shifting, with rules and regulations that seem to change on a dime. Keeping track of all these updates can be a real headache for any firm. But when you outsource your medical billing needs, your partner takes on the responsibility of staying current with all the latest changes. This means you can free up your time to focus on other important areas of your operations.

5. Reduced Labor Costs: Did you know that companies typically spend around 30-40% of their collections on medical billing? By outsourcing these tasks, businesses can cut down on unnecessary expenses. You won’t need to hire a dedicated medical billing team, which also saves you the costs associated with training and keeping them informed about the latest regulations.

6. No Capital Investment: Outsourcing medical billing means you can skip the hefty expenses of purchasing billing software or the latest equipment. You also won’t have to worry about the costs of software upgrades. Since you don’t have to invest in a complete billing system, your overall costs drop significantly, and in many cases, you can get started without any upfront capital investment at all.

7. More Time for Patients: When you hand off your medical billing to a third-party provider, healthcare professionals can dedicate more time to their patients instead of getting bogged down in billing tasks. It just makes sense to focus your efforts on what you do best—providing quality patient care—while letting experts handle the ancillary business functions.

8. Access to Trained Specialists: Many offshore service providers employ skilled professionals who have extensive experience and a deep understanding of the business needs related to outsourced medical billing and coding. They meticulously review and follow up on all payments, ensuring that carriers are reimbursing the correct amounts. Every outstanding claim is monitored until it is fully processed and paid, which helps to minimize overhead costs.

9. Adherence to ICD 10: The latest version of the International Classification of Diseases, known as ICD 10, is becoming a significant concern for the medical community. The recent coding updates have greatly affected time management and payment results for healthcare providers. By outsourcing medical billing, you can ensure that all coding changes introduced by ICD-10 are managed by the outsourcing company, many of which are already familiar with the extensive regulations involved.

10. Happy Patients: For many patients, visiting the hospital can be a lengthy and, at times, unpleasant experience. They not only have to navigate various medications and care instructions but also grasp the associated costs. A knowledgeable and friendly staff can help keep patients satisfied during their stay, while an expert service provider manages all financial concerns. This way, patients won’t be burdened with financial issues and can communicate directly with the professional medical billing team of the service provider, leading to a more effective and efficient workflow for everyone involved.

How Medical Office Force (MOF) helps in medical billing outsourcing

At Medical Office Force, we take a personalized, strategic approach to medical billing outsourcing. Our expert team works as an extension of your practice, ensuring accurate coding, timely claim submission, and consistent follow-up on denials and unpaid claims. By leveraging the latest technology, regulatory knowledge, and proven processes, we help healthcare providers maximize reimbursements, reduce billing errors, and maintain full transparency in their revenue cycle. With MOF by your side, you can confidently shift the process of billing while staying focused on delivering outstanding patient care.

***We are also proud to offer Health IT products certified under the Office of the National Coordinator for Health Information Technology’s

(ONC) Health IT Certification Program. The ONC CERTIFIED HIT® is a registered trademark of the U.S. Department of Health and Human Services (HHS), further reflecting our commitment to high standards and innovation in healthcare technology.

  • Posted on - April 24, 2025

RPM in 2025: What Physicians Need to Know About Getting Paid

by hws2022, posted in RPM

RPM in 2025: What Physicians Need to Know About Getting Paid

As the U.S. healthcare system continues to shift toward value-based care, Remote Patient Monitoring (RPM) is becoming a central piece of the puzzle. In 2025, major changes by the Centers for Medicare & Medicaid Services (CMS) are making it easier and more profitable for providers to get reimbursed for RPM and other care management services.

If you’re a physician, clinic administrator, or billing professional, here’s what you need to know to stay ahead and maximize your revenue.

What’s Changing in 2025?

CMS’s 2025 Medicare Physician Fee Schedule (PFS) final rule has introduced several updates that give RPM and Advanced Primary Care Management (APCM) a major push. The idea is to reward practices that invest in ongoing, personalized care for patients with chronic conditions.

This rule also brings more clarity to coding, billing, and reimbursements, especially for those using virtual care models and serving underserved communities.

Why This Matters: The Push Toward Value-Based Care

Traditional fee-for-service models are slowly being replaced by value-based care. This means providers are now paid for keeping patients healthy and reducing avoidable hospital visits, not just for seeing them in the office.

To support this shift, CMS is encouraging more team-based and continuous care. Remote monitoring and monthly care management are two strategies being heavily promoted.

Understanding APCM: A New Era for Primary Care

Advanced Primary Care Management (APCM) is designed to compensate providers for managing patients in between visits, such as medication tracking, care coordination, and proactive check-ins.

The 2025 final rule introduces new billing levels under APCM:

Level 1: For patients with one chronic condition.
Level 2: For patients with two or more chronic conditions.
Level 3: For patients with multiple chronic conditions and complex needs.

This tiered system lets providers earn more based on the complexity of patient care they deliver.

RPM and APCM

When Remote Patient Monitoring (RPM) is combined with Advanced Primary Care Management (APCM), the real impact is seen in patient health and engagement. By using tools like blood pressure cuffs, glucose monitors, or weight tracking devices, providers can stay connected to patients between visits and respond proactively to any changes in their condition.

This continuous care approach helps identify issues early, prevent hospitalizations, and ensure patients feel supported every step of the way. By layering RPM onto monthly care management, providers can deliver more personalized and timely care, leading to better long-term outcomes, greater patient satisfaction, and a stronger relationship between the patient and care team.

New Billing Codes for 2025

CMS has clarified billing for RPM, CCM (Chronic Care Management), RTM (Remote Therapeutic Monitoring), and BHI (Behavioral Health Integration). In 2025, there will be separate codes for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), making it easier for providers in underserved areas to get paid.

Key RPM CPT Codes to know:

99453 – Initial setup and patient education

99454 – Device supply and data transmission (30 days)

99457 – 20 minutes of care team time (interactive communication)

99458 – Each additional 20 minutes

These codes support billing for both virtual and in-person care.

Good News for FQHCs and RHCs

Until now, many rural clinics and FQHCs haven’t been properly reimbursed for offering RPM or RTM. That changes in 2025. CMS has now bundled these services into HCPCS Code G0511, allowing more flexibility. This update:

1. Supports monthly billing of RPM and RTM

2. Encourages clinics to invest in virtual care technology

3. Offers a higher payment rate under value-based models

4. Helps reduce care gaps in rural and underserved communities

It’s a huge win for providers who were doing this work without getting fully paid.

Virtual Care Is Here to Stay

The COVID-19 pandemic fast-tracked telehealth adoption. Now, CMS is making some of those temporary policies permanent. Virtual check-ins, RPM, and monthly remote care management are no longer just nice-to-have—they’re essential services.

In 2025, CMS clarified:

1. Virtual care is reimbursable with proper documentation

2. RPM must be used for at least 16 days per month to qualify

3. All care plans must be ordered by a qualified professional

4. Patient engagement and shared decision-making are strongly encouraged

If your practice isn’t using RPM yet, now is the time to start.

Key Takeaways for 2025

Here’s what your practice should focus on this year:

  Adopt RPM tools like blood pressure cuffs, glucose monitors, or wearables

 > Train your care team to manage care between visits
 > Document properly using the new CPT and HCPCS codes
 > Serve underserved populations with G0511 billing (for FQHCs/RHCs)
 >Combine RPM with APCM for maximum reimbursement
 >Use care coordinators and technology to streamline workflows

Final Thoughts: Get Ready Now

As CMS rolls out transformative changes in 2025, it’s more important than ever for healthcare providers to align with the new reimbursement models and optimize care delivery. Medical Office Force (MOF) is at the forefront of this transition, helping practices integrate Remote Patient Monitoring (RPM), adopt Advanced Primary Care Management (APCM), and capitalize on new billing opportunities. By offering a combination of expert RCM services, trained virtual staff, and workflow optimization strategies, MOF ensures that providers not only comply with the new regulations but also thrive in a value-based care environment.

Want help implementing RPM or optimizing your billing workflows? Medical Office Force is here to support you with expert RCM services, denial management, and virtual staffing solutions. Let us help you get paid—accurately and on time.

  • Posted on - April 21, 2025

The Role of Denial Management in Healthcare Revenue Cycle Optimization

by hws2022, posted in CCM, RPM

The Role of Denial Management in Healthcare Revenue Cycle Optimization

In the complex world of healthcare revenue cycle management, claim denials can be a significant challenge. Effective denial management is crucial for ensuring financial stability and optimizing revenue cycles in healthcare organizations. By understanding the denial management process in medical billing, practices can minimize revenue loss, improve cash flow, and enhance patient satisfaction. This blog explores the role of denial management in healthcare, its impact on revenue cycle optimization, and how denial management services can help medical providers achieve financial success.

Understanding Denial Management in Healthcare

Denial management is a systematic process aimed at identifying, analyzing, and resolving claim denials by insurance companies. A denial occurs when a submitted medical claim is rejected or not reimbursed due to various reasons, including coding errors, missing information, or policy exclusions. Without a strong denial management strategy, healthcare providers risk losing significant revenue and facing operational inefficiencies.

The goal of denial management is to minimize rejections, streamline resubmissions, and ensure claims are processed efficiently. This process not only helps healthcare providers recover lost revenue but also enhances compliance with payer requirements and reduces administrative burdens.

The Impact of Claim Denials on Healthcare Revenue Cycle

Claim denials can severely disrupt a healthcare organization’s revenue cycle. When a claim is denied, it requires additional time and resources to investigate, correct, and resubmit. This leads to delayed payments, increased administrative costs, and cash flow issues.

According to industry reports, nearly 10-15% of all submitted claims are denied, and over 60% of denials are never resubmitted, leading to substantial financial losses. This makes it imperative for healthcare providers to implement effective denial management strategies that reduce claim rejections and enhance revenue cycle efficiency.

Essential Stages of the Denial Management Process in Medical Billing

A well-structured denial management process can significantly reduce claim denials and improve reimbursement rates. The following are essential steps in effective denial management:

1. Identifying the Root Cause of Denials: 

Analyzing denial patterns is the first step in understanding why claims are being rejected. Common reasons for denials include:

  • 1. Incorrect patient information
  • 2. Missing or incomplete documentation
  • 3. Coding errors and incorrect modifiers
  • 4.Lack of prior authorization
  • 5. Timely filing issues
  • 6. Non-covered services

2. Tracking and Categorizing Denials

Healthcare providers should categorize denials based on their root causes, such as administrative, clinical, or technical errors. This allows for targeted improvements in claim submissions.

3. Implementing Corrective Measures

Once the causes are identified, providers can take corrective actions, such as:

  • 1. Training staff on accurate documentation and coding practices
  • 2. Verifying patient eligibility and coverage details before submitting claims
  • 3. Implementing automated claim-scrubbing tools to detect errors before submission

4. Resubmitting Corrected Claims

Correcting denied claims and resubmitting them within the insurer’s deadline is crucial. Providers should ensure they adhere to each payer’s specific guidelines to maximize reimbursement.

5. Monitoring and Continuous Improvement

Denial management is a continuous and dynamic process that demands consistent oversight, analysis, and proactive intervention to minimize claim rejections and enhance revenue cycle efficiency. Healthcare organizations should regularly review denial trends and implement process improvements to minimize future claim rejections.

The Role of Denial Management Services in Revenue Cycle Optimization

Given the complexities of claim processing, many healthcare providers turn to denial management services to streamline their revenue cycle operations. These specialized services offer expertise in handling denials, improving reimbursement rates, and reducing administrative burdens. Some key benefits of outsourcing denial management include:

1. Expert Analysis and Resolution: Trained professionals identify patterns, rectify errors, and ensure claims meet payer requirements.

2. Faster Claim Processing:  Advanced technologies help track denials in real time, leading to quicker resolution and reimbursement.

3. Improved Compliance : Professional denial management services ensure adherence to ever-changing insurance regulations and policies.

4. Enhanced Revenue Recovery: Effective resubmission strategies help recover revenue that would otherwise be lost due to claim denials.

Best Practices to Reduce Claim Denials

To minimize denials and optimize revenue cycles, healthcare providers should adopt the following best practices:

1. Invest in Advanced Technology: Use electronic health records (EHR) and automated claim submission tools to reduce errors.

2. Regular Staff Training : Ensure billing teams are well-trained in medical coding, documentation, and payer guidelines..

3. Proactive Eligibility Verification : Confirm patient insurance coverage and policy requirements before treatment.

4. Standardized Denial Tracking : Maintain a centralized system to track and analyze denial trends for process improvement.

5. Strong Communication with Payers : Establish clear communication channels with insurers to resolve claim issues efficiently.

Conclusion

Effective denial management in healthcare is essential for maintaining a healthy revenue cycle and ensuring financial stability. By implementing a strong denial management process in medical billing, healthcare providers can significantly reduce claim rejections, improve cash flow, and enhance overall operational efficiency.

Partnering with professional denial management services can further streamline processes, reduce administrative burdens, and maximize revenue recovery. Healthcare organizations can achieve long-term financial success and provide better patient care by staying proactive and continuously refining denial management strategies. 

For expert solutions in revenue cycle management, visit Medical Office Force today!

  • Posted on - February 10, 2025