9 Remote Patient Monitoring Mistakes Practices Make, and How to Avoid Them

The remote patient monitoring mistakes that hurt a program are rarely dramatic. They are small gaps that repeat every month: a consent nobody wrote down, a patient whose readings stopped without anyone noticing, a device that never came back. Here are nine of them, grouped by where they happen, with a plain fix for each. The billing rules below are general federal Medicare guidance; they change every year and differ by payer, so confirm the details with current CMS guidance, your MAC and your compliance adviser.

Mistakes at enrollment

1. Enrolling a patient before consent is documented

What goes wrong. A device ships after a quick conversation, and nobody records who agreed, when, or whether the patient heard that a copay may apply. Months later, the claim has nothing to stand on.

How to avoid it. Make recorded consent the gate for the device order, not a step that happens around the same time. Record who gave consent, who obtained it, how, and that cost sharing was explained. CMS has said auxiliary staff can obtain consent under general supervision and that it can be obtained at the time services are furnished. Our RPM patient consent checklist walks through each item.

2. Sending a device the patient cannot use

What goes wrong. The patient is eligible on paper, but they do not use a smartphone, their home has a weak signal, or they cannot read the screen. The device sits in its box and no readings come in.

How to avoid it. Ask a few questions before you pick a device: does the patient use a phone app, is there a cell signal at home, does a family member help? Match the device to the answers. A patient who will not open an app may do better with a device that sends readings on its own.

3. Not asking whether another practice already monitors the patient

What goes wrong. Only one practitioner can bill the RPM device codes for a patient in a period. If a patient is already monitored by another office, a second enrollment can lead to a denied claim and a confused patient with two devices.

How to avoid it. Ask the patient directly at enrollment, and record the answer. If they already have a monitor from somewhere else, settle which practice continues before anything ships.

Mistakes in the monthly work

4. Counting readings the device did not send

What goes wrong. A patient calls in their numbers, or staff type a reading in from a paper log, and it is counted toward the month. Medicare expects RPM data to be physiologic and transmitted automatically from a device that meets the FDA definition of a medical device.

How to avoid it. Keep self-reported numbers in the chart as notes if the provider wants them, but count only readings that arrived from the device. Your software should show which is which.

5. Letting reading days slip without anyone noticing

What goes wrong. The long-standing device codes (99453 and 99454) call for readings on at least 16 days in a 30-day period. A patient stops measuring in week two, nobody notices until the period ends, and the month cannot be billed under those codes. CMS added shorter-period codes for 2026, including 99445 for 2 to 15 days, but payers can treat them differently.

How to avoid it. Watch reading days while the period is still open, not after. Set a rule for how long without a reading counts as missed, and call the patient when they cross it. A short call early in the month can still save it.

6. Counting time with no live conversation

What goes wrong. Staff spend 20 minutes on a patient's readings, leave two voicemails and send a text, and bill 99457. CMS expects 99457 to include at least one real-time, interactive communication with the patient (or their caregiver) in the month. A voicemail or a text does not meet that.

How to avoid it. Plan the monthly conversation early. Put it on someone's list in the first part of the month, and record whether the call reached the patient. If the patient cannot be reached after several tries, flag them for a different approach rather than trying again on the last day.

7. Logging time from memory

What goes wrong. At the end of the month someone writes "25 minutes" on each patient from memory. The numbers look round, they do not match the activity in the record, and nobody can say what the time was spent on.

How to avoid it. Record time as it happens, by person, by patient and by day, with what it was spent on. When a figure needs correcting, add a correction with a reason beside the original instead of overwriting it. Our RPM documentation checklist lists what a patient month should show.

Mistakes in running the program

8. Having no clear plan for who answers an alert

What goes wrong. A reading comes in high on a Friday evening. It lands in a shared inbox, everyone assumes someone else saw it, and on Monday it is still unread. Or one person carries far more patients than the rest and falls behind.

How to avoid it. Give every monitored patient one named staff member, plus a backup for when they are out. Have the provider set each patient's limits, write down who reviews what and how fast, and decide what happens outside working hours. Tell patients that monitoring is not an emergency service. Our guide on how to staff an RPM program covers roles, coverage and caseloads.

9. Losing track of devices

What goes wrong. Devices go out with no record of which serial number went to which patient. When a patient leaves the program, nobody asks for the device back, and when one does come back, nobody knows whose it was.

How to avoid it. Record each device's serial number (or IMEI for a device with a SIM) when it arrives, when it ships and when it returns. Start a return when a patient disenrolls, send reminders, and check every returned device in before it goes back on the shelf.

Frequently asked questions

Why does an RPM month end up not billable?

Two gaps are worth watching first: too few days of readings in the period, and no live conversation with the patient in the month. Both can be fixed while the month is still open, and neither can be fixed after it closes.

Can a text message count as the interactive communication for 99457?

As general Medicare guidance, no. CMS describes the interactive communication as real-time and two-way, such as a phone or video call. Check how each of your payers defines it.

Should every patient who qualifies be enrolled in RPM?

Enroll patients whose provider documents a reason for monitoring and who can and will use the device. A patient who never takes a reading gains nothing from the program and adds work for your team.

Who should catch these mistakes?

Build the checks into the work itself so they do not depend on one person remembering. A gate before the device order, a reading-day watch during the month and a time record kept as work happens cover several of the mistakes above.

Sources

• Telehealth & Remote Monitoring (MLN901705), CMS
• CY 2021 Payment Policies Under the Physician Fee Schedule (final rule), Federal Register
• CY 2024 Payment Policies Under the Physician Fee Schedule (final rule), Federal Register
• CY 2026 Payment Policies Under the Physician Fee Schedule (final rule), Federal Register