Transcript
Marla: Welcome everyone, and thank you for joining today's webinar, remote Therapeutic Monitoring in 2026 from technology add-on to Core strategy. I'm Marla Ranieri, head of Clinical Innovation and Clinical Strategy at Prompt Health, and I'll be moderating today's conversation. We brought together an incredible group of leaders who are not just talking about RTM, but actively implementing it, scaling it, and helping shape what it looks like inside real clinical environments and care models.
And what makes this conversation particularly important right now is that RTM didn't just suddenly become more relevant because technology improved. It actually became more relevant because care delivery itself is changing. Clinicians are being increasingly expected to manage care longitudinally, and not just during in-clinic visits, but between visits and patients are becoming more accustomed to those digital touch points through all aspects of their life.
I'm sure many of you have an Apple Watch or a Fitbit or an aura ring. Um, there's just growing expectation to monitor progress, adjust plans in real time, ensure adherence outside of our four walls, and prove successful outcomes. So RTM does provide all those additional data capture and data points to help change your care model and to help do that.
And this really aligns with a broader shift that's happening in physical therapy right now where physical therapists are being positioned as first contact or primary care providers for MSK care. And with that shift comes a higher standard. So CMS has made it very clear, especially with the 2026 updates, that RTM is not intended to be a billing opportunity or a tech add-on.
It's intended to support a fundamentally different care model. So that question is no longer can we bill RTM. The real question is, do we have the right tools and knowledge to operationalize RTM in a way that improves patients' engagement, improves outcome, and creates sustainable care delivery models?
And that's exactly what we'll unpack today. Uh, but before we introduce our panelists, just a couple of quick housekeeping notes. We want this to be really interactive so you can see there is a chat. Please share your experience in the chat. Say hello, tell us where you're from and any reflections you have throughout this webinar.
However, if you do have a question, we would ask you to put it in the q and a button at the bottom of the screen. This way we can answer that question on demand or at the end when we do q and a or of course afterwards if we don't get to it during this session. Um, and with that, like I said, we want lots of engagement.
So we're gonna start with a poll. You'll see that popup on your screen, and we wanna know what best describes your current experience with RTM. So are you not using it yet? Are you exploring but haven't launched? Maybe doing a pilot, fully implementing it, um, or scaling across your organization. So let's let everyone take a second or two to answer that poll.
Great, and hopefully we'll see some of the results on the screen after you answer that.
All right, perfect. All right. So we look like we've got a lot of people exploring it, but haven't launched and then, uh, and some not using it at all. Okay, great. Um, and then with that, I'll have one more poll question for you. What's your biggest challenge with launching or scaling RTM? So again, you're gonna see that pop up.
Um, just maybe billing and reimbursement if you don't have the confidence there, or if you think it's too much of a work lift or burden, uh, unsure which patients qualify or, you know, really haven't found the right technology or it just didn't stick. All of these different options. Let you guys fill that out and then see where everybody lands with that question.
And I, I love people dropping in the chat as well, so thank you for that. All right, so we'll close that poll and see those there. Okay, perfect. Lot on reimbursement, um, and the staff lift. Okay, great. So whenever we run these polls, we kind of see a lot of the same, where people are sort of in the middle.
They, they may be exploring it or they haven't even tried it. Um, and a lot of the gap is the awareness and the successful integration into your clinical model, and that's where a lot of the friction exists and what we're gonna really be talking about today. So we've got a great list of panelists that will be able to dive in and be subject matter experts in this.
First we have Vikram Sethuraman. Hi Vikram. All right. Vikram is the Vice. Oh, Vikram is the Vice President of Product for Prompt Engage, which is formerly known as PT Wired, and he's been deeply involved in building patient engagement and RTM infrastructure that helps clinics prevent patient drop off and operationalize RTM in scalable ways.
Great to have you. All right. Next, we're joined by Lang. , say hi to everybody.
Bryan: Hey, Marla. Hey everybody.
Marla: And Bryan Lang is the owner of Whole Body Health Physical Therapy, as well as the owner and director of strategy at Tandem RTM. Bryan works directly with clinics across the country to launch and scale RTM programs with a focus on workflows that are sustainable and clinically aligned.
And joining us from an operator operator perspective, we have Mary Rose Strickland. Hi Mary.
Mary Rose: Hello,
Marla: and Mary's the President and Co. Mary Rose is the president co-owner of New Life Physical Therapy in Wisconsin. She's a board certified orthopedic specialist and she brings both clinical and executive leadership experience and is firsthand insight into what it takes to make RTM work inside a clinic.
Great. So, um, with all of these, with all of these panelists and guests, we wanna just start and set the stage at a high level, and Vikram, I'll throw this question to you first, but what is RTM really designed to do clinically and what changes happened at CMS recently in 2026 that really signaled RTM is meant to be used and not just build?
Vikram: Yeah, so RTM stands for Remote Therapeutic Monitoring and it refers to the set of CPT codes now that have been live for a couple years, which allow us to basically bill for the services. We're providing in between clinic visits to monitor patients, collect data on patients, and use that data and monitoring to ultimately make the best possible clinical decisions with their plan of care.
Um, so I'm gonna go through the codes at kind of a high level here. Um, this isn't gonna be a, in the weeds of all the requirements or anything like that. This is gonna be a high level overview of, um, the codes and then also what's new. Um, but we're also always happy, uh, you know, on a separate call if anybody really wants to get into the weeds and different interpretations or anything like that.
But at a high level, um, these are, uh, the three codes that we call the patient usage based codes. And the, the reason I refer to it that way is because. Part of the requirements for these codes are based on the patient's usage of the device or of the system which you're using for remote therapeutic monitoring.
And that's kind of a key part of RTM is you need to have some type of a medical device. Most people use software as a medical device, which you're providing to the patient, which allows you to monitor that patient in between clinical visits and then collect the data. Um, that need for RTM purposes. First code here, 9 8 9 7 5.
That's for the initial setup, um, of getting that device to the patient or that system on the patient's device. Um, that's billed once per plan of care once for Epic episode. That's about $21 there. Um, the next code 9 8 9 8 5 is billed once every 30 days throughout the plan of care, and that's based on the data that we can collect from the patient's device.
Um, data is, you know, very uh. It depends what type of system or device that you're giving to the patient, but a lot of times this can be data like exercise completions, outcome ratings, activity, um, trackers, different things like that can qualify as data transmissions that we're collecting through the device.
And we need to collect two to 15 days of data transmission over a 30 day period to bill 9, 8 9 8 5. If we get more than 16 days of data transmission, then we can bill 9, 8, 9, 7 7. They're both paid the same at about $50. Um, 9 8 9 8 5 is a new code for 2026. Previously we only had 9 8 9 7 7, which meant that the threshold of activity that we needed to hit for a patient to be, or, or the threshold of, of data collection rather, that we needed to hit for a patient to be eligible to bill one of the data transmission codes was quite high.
So now one of the exciting things for, uh, 2026 and beyond is that we have a new code which applies to lower levels of data collection, which is also paid the same. So these are the patient usage based codes. The next set of codes are what I call the provider usage based codes, because it's based on the provider's time that they're spending, monitoring the patient, updating their care plans, et cetera.
First code is 9 8 9 7 9. This is for the first 10 minutes of RTM treatment management services in a calendar month. Um, and it includes one live interaction, which is, uh, one synchronous interaction with the patient, whether that's a phone call, um, FaceTime, a video call or, or an interaction in person, as long as it doesn't overlap with other billable time in the clinic.
And this is paid at about $26. This is a new code as well for 2026. Previously was just 9 8, 9 8 0 and 9 8 9 8 1. So 20 minutes and beyond. So now we have a different code, which applies again to a lower threshold there, um, for 9 8, 9, 8 0. It's for the first 20 minutes and you can't bill both seven, nine and eight zero.
So it's not like you get paid for the first 10 minutes, and then for the first 20, it's either seven, nine or eight zero, depending on the total number, the, the total amount of time during that calendar month. Um, and then for 8 1 9 8 9 8 1, that's for additional 20 minutes of RTM time, um, per calendar month.
So if you hit 40 minutes, for example, you would bill one unit of eight, zero, and one unit of eight, one assuming again that you have that live interaction met as part of the requirement there. So I know that's kind of a very high level, um, overview. Like I said, we're happy to go into the weeds if, if people need to on, you know, a separate call.
We're more focused on strategy and implementation on this webinar. Um, but as far as why these codes were introduced in new codes, the simple of it is that RTM works. You know, we, we have a couple years now that RTM has been live. We'll get into this a bit later in terms of the actual data, um, that has been collected in terms of how RTM impacts retention, outcomes, adherence.
There's lots of data now because we have several years of RTM being out in the space. Um, so if you haven't implemented RTM, which I saw in the polls, a lot of you have not. And if it's on your radar, now's the best time to start. Um, one look at, um, this is for prompt health for our RTM claim Submitted. If you look at the months here for January, uh, last month, we saw a huge spike in the number of RTM claims submitted, and it's because of these new codes.
'cause now the thresholds are way easier to hit than they had been in the past. Um, so RTM is, it's, it's a better time than ever to implement it, um, as you can see by the numbers here. Um, so if you're taking a look at implementing now's, now's the right time.
Marla: Oh, that was so, so great. Vikram, thank you so much.
It's great to hear all the changes and the positive changes that are being made. Um, and I wanna punt a question to you. Since you are helping people implement RTM and also doing this in your own clinic, what do these changes mean? If you're already doing RTM, so someone who's been doing it, what does these changes mean for them and what impact will it have for someone who's just starting RTM in 2026?
Bryan: Well, I think that the Vikram hit the nail on the head a little bit with just these thresholds lowering. I think that's a big thing to, to consider, uh, first and foremost because. CMS really only has a couple ways to dictate how we move as an industry. It's, it's the thresholds of the ability to actually generate the codes so that threshold got lower.
That should be an indicator. And it's based on reimbursement too. Um, Medicare has the ability to decrease reimbursement. We've seen it with manual therapy, and that is kind of their indicator of how they want the industry to move. So what in general, what I'm seeing here is that CMS is saying, we want you to use this.
We want you to actually implement this because we're asking you to start doing more population health. Um, and so it's like starting with the individuals who don't have our TM set up yet. That's okay, but consider this another message from CMS, that this is something that we need to start considering. We need to start talking about.
We need to start developing a plan. Um, and then for those who have already started R tm, it's almost like it's an addit. It's, it's just even a little bit easier. To do what we were already doing because those thresholds being lower.
Marla: Icing on the cake. I'd say for sure. And we know that CMS and payers don't ever, um, benefit us positively unless something really is working.
They're normally decreasing our reimbursement and our codes. So this really means kuda to all of those who. We're the, the spear headers of RTM because the data's there and it is showing that it's driving outcomes, it's improving adherence. Um, and that's why CMS has made these changes. Um, so really overall, it's great to see this, and it really should help you guys think a little bit more about how you're using this in your care models, not just adding it as a tool and a billing, because then, as we know, if you're just doing that, CMS may change these codes.
So we do really wanna talk about that part, how to make it as a care model. Um, and the real question of course, is what does this look like operationally inside a clinic and how does your technology support that? So with that, um, Mary, I'll actually start with you. Uh, if you can ask me what looks different day to day when RTM is truly part of care delivery instead of layered on top.
Mary Rose: Yeah, absolutely. I think the key thing is it's the overall experience that's enhanced with our tm. This isn't just a, here's how you access your home exercise videos. That just leverages the technology, but rather you're going to get a phone call from somebody. Um, and, and we build it as this is a, a person that's part of our team, part of the overall experience.
We have enhanced communications. If there's early questions, if there's issues, we're able to catch those way earlier on, which helps our overall retention. It helps patients to, you know, feel like they can be successful early on, so they come back for their follow-up visits. And truly, it just doesn't help with the plan of care, but it helps us stay connected with patients.
And so with access being an issue, I think RTM is an opportunity to really connect whether you're in a more rural environment, maybe staffing issues in your clinic. You don't have a lot of providers, but you can really enhance, um, the way that you can communicate, connect with your patients, engage with them, not just over a plan of care, but hopefully over the course of their lifetime.
Marla: Would you say this really has created a hybrid care model for you in your clinic?
Mary Rose: Absolutely. It opens the door to that. It allows patients to see how easy that can be. I think a lot of times, you know, people do come potentially with different levels of comfort and, um, it's a, a low entry for, for a barrier to be able to see how this can work and, you know, proof of concept of how we can, can use technology to stay in touch and work with people through a, a plan of care and and beyond.
Marla: Great. And Vikram, can you walk us through the three most common RTM implementation models and how clinics use 'em today?
Vikram: Yeah, so the, the three main ones, we call them full service, self-service, and then, um, kind of a hybrid, which is, uh, a mixture of the, of the, of both of those. So the full service is basically, um, some people call it white glove.
It's basically where you work with a third party company who staffs the providers who then. Provide the RTM services and in some cases assist with the billing for the RTM codes. This is kind of the, the least, uh, disruptive, I guess for clinical workflows because you're basically, um, not having to block out provider time for the purposes of, um, introducing RTM or, uh, actually providing the RTM services.
Um, the trade off there is that you're often paying a fee, well, you're, you're always gonna be paying a fee for that extra service that you're working with that third party with. Um, and then the next one we call self-service, which is essentially each provider at that clinic manages RTM for their own patients.
Um, so it's, it's kind of fully up to that provider to do all the RTM services provisions as well as the billing for all of their specific patients. Uh, and then the last one. Is kind of a hybrid between the two, where basically you still have a pinpoint RTM provider or providers, depending on the size of the clinic, um, who manage the RTM services provision, as well as, um, you know, assisting the billing.
Uh, but then they're internal, you know, so they're still working with the patient, the clinical provider's, patients. Each provider isn't having to do their own RTM. You have somebody else who's doing the RTM for that provider. However, that person is internal rather than external. Um, the advantage there, of course, is that you, uh, retain all of the revenue.
You're not paying a fee to a third party company. Also, some people like the fact that it's, um, you know, a clinician from their brand, a clinician from their organization that's doing the care, regardless of if, if it's, um, the clinician or the RTM provider. Um, of course the trade off is then you have the staffing costs of actually getting that provider, making sure they have enough volume to keep them busy.
Um, as well as. Um, the admin time and, and the whole admin of the implementation that they need to do to basically make RTMA success. Um, each one has its pros and cons. Each one can work well depending on how the clinic is structured, as well as the goals of the clinic with RTM. Um, so to, you know, we'll talk about each of these on, on the webinar today, but ultimately, you know, lots of different people on this, on this webinar will have, um, a different answer of which strategy makes sense for them.
Marla: Great. Great. Um, and , I know you, you are helping people do all these different types of strategies. So is there any kind of quick, uh, tip about maybe this strategy's best for starting off or a large clinic or a small clinic? Uh, any thoughts on that?
Bryan: Um, I think a lot of it has to do with when it comes to leadership, like what are your.
What are your most important directions? Um, because when you start launching, let's start with just, if you haven't launched RTM before, there is, it's like trying to get the snowball rolling down the hill. There's a lot involved of like, okay, this is, uh, a different vertical that we need to implement in our company in terms of who is doing the, the managing of this, who's actually doing the actual work, and then how are we making sure that we're hitting our metrics and getting this all billed out correctly.
None of that is anything that's foreign to us as clinic owners. It's more about do we have the space to talk about, you know, who is doing what, so we have this plan to roll out. And then finally going into, um, how are we getting this messaging out and how are we educating our staff consistently? Um, I think communication is probably the biggest driver of success on this.
And if you haven't talked ad nauseum about different things about R tm, you probably not doing it enough. Um, so. That's kind of like the biggest thing on there. What, sorry, I might have missed the overall question there, but that's what communication is the biggest thing. Um, so I think that's probably the main thing I would talk to any, anybody interested in and who wants to talk to me.
I talk a little bit about what are your main initiatives and that helps drive, like is RTM right for you to do in, in-house or, uh, with a third party.
Marla: Great. Perfect. And I know, uh, Mary Rose, you had such a good point about it really needs to be a teammate and it needs to be embedded in all you do. Uh, so we'd love to talk about, okay, well what is the real world implementation?
How are you personally using it in your clinic right now? Um, the model, uh, how you landed there and just overall how you're utilizing it.
Mary Rose: Absolutely. So we're using the full service model. So we have a third party who is providing the, um, labor for, um, the provider to make the calls and to do all the monitoring.
And what's really great about the program is from day one, we introduce and we brand that person as part of our team. And she is, she's contacting our patients. If there's questions or concerns, she has access right through the prompt system she can send us at tags. Um, it's no different as if, you know, she were just in one of our other clinic locations compared to where we're at.
So from day one, they see her face, they understand she's going to be calling, um, they come back, oh yeah, I spoke with Laura and this is what she had to say, and this is, you know, and, and by then we already know it. So like, yep, we talked to her too, and this is, this is what's going on. So from that standpoint, um, it's, it's really, I think, important to make sure that the patients understand that we're all part of the same team.
We, we've got the same goals in that regard. And I think that's really important for the success of the program too. Um, for us, the full service. Was the right choice just because, um, we, we, staffing is an issue. And so I wanted to keep my providers seeing patients and being able to generate, um, you know, direct treatment, one-on-one codes, so we're able to, you know, leverage this and, and not have to put it off because otherwise, if we were gonna do it ourselves, we'd have to put it off.
Um, also something that just from a billing perspective to, to be able to have the expertise on, on the billing and the reporting side of it, to look at, okay, now how are we doing? Um, what changes can we make and how can we make sure we leverage this? You know, moving forward we're seeing great value in that full service model.
Marla: Great. And a couple questions came from the audience of, are you using PTs or PTAs, uh, in that model? And are you doing it for all Medicare or, um, all patients? Just in general, what types of patients.
Mary Rose: Yeah, so we have A-A-P-T-A that works with us, um, who's been assigned with us, and can speak more to that. Um, at this point in time, we definitely do it with our Medicare patients, but there are a variety of other payers. Um, so, you know, we worked through a process with and Vira when we first started with this in regards to being able to test it and make sure that we're only, you know, utilizing on the patients that we know we're going to get reimbursed.
So through that process, we were able to find out, and now we have a list. So there's a list set up. All of my providers know this is the list of payers we can use this with. Prompt. Makes it super easy to set that up, um, with rules so that it automatically is recognizing this is the group or this is the person who's eligible so that we can, you know, go ahead and get that turned on and move forward with that process.
Marla: Great, thank you. And , what about you? How are you utilizing RTM in your own clinic? Um, just the model and how did you implement it and land there?
Bryan: So, I mean, it may not be completely fair 'cause uh, I do this for other groups as well, but I would consider us one where we do it ourselves. Um, and, uh, it made sense because I've been doing this for a very long time and I know the process around doing it, um, to the point of, you know, what insurances do you start with?
I consider any kind of rollout rollout with RTM phased. So the first phase is you, you do it with, um, insurances that, you know, cover the codes and then you start in the second phase looking at other insurances and getting more information, uh, locally on or regionally on how they pay. Um, and that's when you start to see kind of growth in the program itself.
So for our company, um, it just, it made complete sense to do it in-house, um, because we had the team already kind of in place.
Marla: Great. Perfect. Um, and Vikram, there's a couple questions coming into the chat just about if the PTA needs to be in the same state, um, and if Codas can do this as well. So if you can answer that for us.
Vikram: Yeah. So, um, first, lots of great questions. I see. Please make sure you put it in the q and a versus the chat. 'cause it might get lost in the chat as we're, as we're going through things. But, um, the PTA needs to be licensed in the state that the patient is in. Um, so that's no, or, or, or the provider in general.
You know, it has to be licensed in the state that the patient is in. Um, who's providing the RTM services, um, assistance can, uh, provide and bill for RTM, some of the codes, uh. We'll need the CQ modifier if the assistant has contributed more than 10%, um, of the requirements. So if you're thinking about the time-based codes, if they've done more than one minute out of the 10 or two minutes out of the 20, or if they did the initial setup, then you need to add the CQ modifier.
Um, if you're using engage, that's tracked by the system, that'll automatically port over to prompt that if, if the modifier is needed there. Um, and then the data transmission codes do not need the modifier. They, those will nev, the CQ modified does not apply to the seven, seven or eight five codes.
Marla: Great.
Bryan: And, and just, just specifically to Coda doesn't is included. So PTAs and Codas, those are all fair game. Perfect. Uh, and, and, uh, sorry. One more thing about that too is that you do have to be like a similar discipline. So a pt, uh, doing the plan of care needs a PTA, an OT with the plan of care needs a, needs a coda.
You can't switch disciplines.
Marla: Perfect. Great. Alright, well, getting back into the implementation and some lessons learned, um, what would you say is the most common mistake clinics make early on? Uh, and , Mary Rose, whoever wants to answer that,
Bryan: I'll start. Um, I, I really think that he is gonna hear a very common theme and it's, it's the, the communication.
It's really about getting the communication out, talking about, um, you know, what is true about RTM and what isn't because in, in all honesty, it is brand new. And so it requires the leadership team to really say, okay, we understand you're gonna have a lot of questions. We're gonna get ahead of those questions to begin with even before we go live.
Um, and we're gonna have discussions about all of this. And then when it does go live. That doesn't mean that the communication stops, um, that means that we're gonna continue to talk about things and now we're gonna start seeing some metrics, and now we're gonna actually begin to like, use those metrics to talk about how this is influencing things.
So oftentimes I talk about, you know, one to two months is where everyone's still kind of like feeling it out. You know, I do, I like it. I can't tell three to four uh, months. You start to have the providers have a little more understanding of the language that they use and when they use it, and then five to six, we really should start seeing like, okay, this is becoming a lot more normalized.
I'm starting to see the picture. I got some more ideas actually about how to make this better. And that's, that's really exciting. But I, I, I think the biggest thing is communications.
Marla: And I would say too communicating the why Yes. To the patients and to your providers. Because I think if they just, your providers just see this as a billing edition, we're just gonna bill more codes.
They are not gonna buy in either. They've gotta really understand this is a better way to care for your patients. This is a better way to check in. And as you said earlier, population health, manage them, have more touchpoints and data to really provide the best outcomes you can do and keep them engaged.
So, uh, love that. And, um, and would love to hear, uh, from your perspective as well, Mary Rose, anything that you wish you'd known before starting RTM that may have made it easier or hope it stick sooner?
Mary Rose: Yeah, absolutely. Um, we actually had the experience of, we did start it, um, a year prior to, to being on Engage with Prompt, and so we did have another experience, um, and it didn't go great and we learned a lot of lessons through that, which, um, thankfully kind of made things, uh, be a lot more successful the second time around.
And for us, one of our biggest issues was related to the billing. Um, and just understanding what that process was going to look like, um, with patients, um, and having. The, the visits were going, the, all the codes were going out on a date of service where patients weren't seen. And so there was just some, some transparency issues and questions that came up.
And so having a billing system that, number one, your clinic really understands how is this working? So then you can clearly communicate that to the patients. Um, but the process that we work through with prompt, um, they're added right to actual dates of service. So they're not. Something that's mismatched.
So that was definitely something that's been, been much better at this point in time. Um, and then really, like we've kind of touched on already with the providers, this is to help also make their jobs easier. As providers, we're being asked to do more and more and more in a shorter period of time, getting paid less and less to do so.
And so this is just an opportunity to truly enhance and say, Hey, you know, our clinic, we used to love making phone calls after an eval to see how is a patient doing and how did they respond. And just with time and demands, we got to the point we could no longer do that. And so, you know, just to frame it as this was an opportunity to do that again, and our patients love it and our providers can see, you know, it's an opportunity to actually take some of the workload off of, of their direct, um, you know, plate, but still be able to, you know, offer that experience to the patient.
Marla: And I love that perspective that you, you did try it with a different system and so forth and sometimes it's not necessarily the RTM that's not working, it's the process behind it or the seamless integration to be able to make it easy for your clinicians and your patients to engage. So for those of those who may have tried it and don't think it's successful, don't think that that's the end.
Maybe there's an alternative solution to keep seeking out. 'cause it does look like it's being very successful for many, many people. Um, well you also mentioned friction. So wanna talk a little bit about friction and common challenges. So Vira, where do you feel that most clinics struggle when translating RTM policy into operations?
Vikram: Yeah, so it definitely depends a little bit of which implementation strategy they pick of the three models because each of the models, um. As we mentioned, have different pros and cons, which apply to the different struggles that may come up. Um, for example, if you choose self-service, one of the struggles you may have is that you need to have every single provider educated on RTM, um, in the, in the know about which payers you guys are billing for, um, about the billing, all that.
Um, and then, you know, so, so that's one, uh, thing to consider is that depending on the strategy and implementation model, you may have different struggles, but kind of across the board, uh, we, we see people struggle with billing at the beginning. Um, kind of going back to what Mary Rose briefly alluded to, there's different advantages, um, pros and cons of billing in certain ways for different payers.
Um, I wish there was a single like billing strategy that I could cover on this call and say, Hey, bill RTM codes like this, and it'll be the best. Definitely not the case like that. Um, that being said, one thing that we've been able to do is, um, since you know, we have access to all the claims RTM claims submitted for prompt, we have a lot of data that now we can help clinics with when we get onto live onto calls with people, and then we can see which payers you guys primarily have, um, what RTM reimbursement, uh, data we can see for that.
Payer for other clients doesn't necessarily guarantee that they'll treat you the same, but also how that's been submitted in the past, whether it's been submitted on the same data service, whether it's been submitted as a separate data service, um, the pros and cons of each of those. Um, so that's, you know, we'll, I know we'll touch on billing a little bit more later on this, but, um, that's another struggle.
But one of the more, you know, the biggest problems that we actually see is provider buy-in sometimes getting the clinicians at the clinic to buy into what, to, to the idea of RTM and then basically set up their patients. On the system, on the app or, or whatever you're using for RTM. Um, so then whether it's somebody internal, whether it's somebody external to then give them a call, provide the RTM services and ultimately bill them.
Um, that's kind of one of the biggest issues we've seen is provider buy-in. So one of the, um, follow-ups from this webinar, if you've registered, which everybody on this call obviously has, uh, one of the things that we're gonna be sending out in a couple weeks, uh, is a one pager, which is designed to be given to clinicians, um, to basically kind of motivate them and get them to buy into RTM.
As I mentioned earlier, there's lots of data now on RTM, how RTM impacts outcomes, retention, adherence. We did a study internally at PROMPT and we saw that. Patients who are RTM versus non RTM on average, and this is across several clinics, have five and a half more attended visits per plan of care than non RTM patients.
So there's lots of other, um, return on investment metrics that you can look at, which providers will certainly see value in more than just how much RTM revenue are we making. Um, and this one page that we'll be sending out is designed to basically address that pain point. Um, but yeah, tho those are the main challenges which we've seen, um, clinics face.
Marla: Great. And you, you mentioned provider buy-in. So Mary Rose would love to know from your perspective, uh, what's actually worked to address the provider buy-in issues that you may have done or, and you can chime into as well.
Mary Rose: I think, um, you know, again, just being able to allow them to see, um, you know, the benefits to the patient and recognizing you don't have to be the one to sit there and, you know, go through and troubleshoot all of the technology.
That's, that's part of the reason why we have the support of this other provider to reach out and ask how they're doing with it and, you know, troubleshoot those problems in somebody who, again, through the full service, who understands that program way better than we do. So it allows us to kind of focus on what we know, um, allows them to focus on what they know.
Um, so, you know, from that perspective, it's being able to say, we're going to use an electronic method for, um, home programs regardless, but at least in this way, you have another partner in that care model who's going to help the patient feel successful with what they're doing, which ultimately is going to allow them to be more successful in adhering and hopefully then see better outcomes.
So I think from that perspective, when they can see and understand that and recognize and. It's not them as the individual provider who's responsible for, you know, troubleshooting and coaching and teaching the technology side. Um, that's been, you know, very helpful. Um, and then the system making it easy to enroll, you know, it's, it's very, uh, again, simple, um, straightforward.
You can set up the rules so it's not something they have to necessarily remember and go through these extra steps. It just kind of happens as part of that system, which is nice.
Marla: Go ahead, .
Bryan: Yeah, maybe to piggyback on that, I think that one of the fundamental pieces of this are, is if we look at it at ourselves, honestly as an industry, people aren't doing their home exercise program the way we ask them to.
Just, let's just be super transparent about that. And, um, I think that, uh, a lot of times I'll ask providers if they've been to physical therapy before, and if you look at your entire plan of care, out of a hundred percent, how compliant were you with your home exercise program? We always have people who are like, you know, okay, they did, they were great, but most people put themselves probably around like a 70 or 60%, maybe 50.
And then, you know, I'm, I'm looking at them and saying, well, we are as physical therapists, like we know the value of pt, right? We believe in it. We should be the best patients and we're still getting C's, D's, and F's. So what are our patients really doing? And that's not a problem with, you know, I think that's a problem of the system because we get paid by our visits, not what happens in between until now.
So now we have this opportunity to pierce this veil of what the heck is happening between the PA when the patient leaves our four walls and when they come back. Right? Um, and that's huge and impactful because if we as PTs truly believe that our plan of care is more important in terms of what is happening between there, then this should be a, a perfect alignment.
RTM and, and how we treat.
Marla: So well said. I mean, I think that just dropped the mic on that it really is, the way it's changing too, is being able to be a coach and not just check in on home exercise program, but health and wellness that RTM provider can be checking in a lot of different metrics. Um, GA and nutrition and sleep and all of that is really where this is headed.
So I think it's a, a great starting off point for how we're managing them on a long scale. Uh, and Vikram, you mentioned a little bit about interactions, like live interactions being a bit of a challenge and a problem. So any thoughts Mary Rose or Vikram on how to make sure you get those live interactions and you're able to, um, mitigate those challenges?
Vikram: So, um, the, it can definitely be a challenge if one of the ways you're getting live interactions is calling patients at unscheduled times throughout the calendar month. Um, I, I saw somebody put a question in, in the q and a about this as well. By the way, we have a ton of questions. There's no way we're gonna answer them, but I will promise I will email every single person with an answer to your question.
So keep 'em coming. If I know we already have over 50 in the q and a and a lot in the chat, but keep 'em coming, we'll get back to everybody. Um, one thing that was clarified in the final rule of last year. Was whether in-person time can count as a live interaction. It was more kind of explicitly said that it can count as long as it doesn't conflict with billable time.
Um, which means if you're, you know, billing, for example, therapeutic exercise for that block, and then while you're doing that, you're explaining the system or the app or whatever to the patient, you can't count that as a live interaction. So what some groups do that we work with is at the end of their eval or at the end of a visit, um, they'll leave some time, some minutes open, um, and from a billable time perspective.
And then during that time, they'll explain the app, they'll explain RTM, they'll explain, you know, the features of whatever device they're providing to the patient. And then that can count as a live interaction for that specific counter mode. Um, this is obviously something that you'll do on the self-service model.
You're not gonna do this if you're working with a full service company or if you have a pinpoint RTM provider. Um, you, you know, it's, it's more likely that you'll do it on that self-service model. So, um, that's one strategy. But one of the good things about working with those, uh, full service, uh, companies is, you know, that's what they do is they'll, they'll, their whole thing is finding time to get the patients on the phone, getting that live interaction done, getting all 10, 20, or 40 minutes of monitoring time done during the calendar month so that you don't need to change how you guys do things in the clinic to get that live interaction completed.
Marla: Great, great. And altering that live interaction. Don't always call them on a Monday at 2:00 PM the exact same time. You know, making sure you're actually alternating those times that you're doing that I think is really beneficial too. Um, and that brings up a big question. I know tons in the chat about it.
Just overall common mistakes with payers, insurance and billing questions. And , I'll let you start on that one.
Bryan: Yeah, I think that, uh, uh, the biggest thing would be, 'cause the question is how do you handle patient responsibilities, right? Like that's, that's a big fundamental one. Um, and it gets be, and it becomes more of a question as you move into commercial payers because plans are different, uh, by, at the plan level for commercial payers, the biggest thing I'll say is that the best thing you can do is own it own RTM.
We do it, we charge for it. This is what can be expected. We consider it a value. We consider it the same value that we, it would be if you had a copay for an treatment physical therapy visit. The data is showing it that outcomes are better. We model our care so that we can help with our visit, you know, utilization, because we have RTM implemented, we, you continue to show that value to the patient too.
And then when you have that full transparency, that's a huge part of that, that journey. 'cause you just, you just explained it and now we're a little bit again, more aligned. Um, going from the billing end, I think that there is a lot to unpack with different billers or different companies and how they, and how they, how they, how you should bill them, uh, in order to get paid appropriately.
Um, there are nuances in terms of denial management. All of them are, are fixable. Um, but that's why we typically do this in stages because. You don't always know what you're getting yourself into until you start doing a few tests, getting promotion, billing a few out, and seeing how some of those regional payers are paying them, and then making decisions on what you're gonna do from there.
Marla: And Kelly mentioned something really great in the chat about how if you do this RTM right, and you explain it right, they might not be able to, they might not have to come in for as many visits. And believe it or not, I know sometimes that sounds crazy to people who only measure length of stay and, um, overall, um, how many visits you've had in total.
But if you can get them better, faster in less visits, that's more time for them to have at home. And it also is more time for you to see a new eval, which is really valuable, getting access a new patient in the door and evals are reimbursed at a greater rate too. So we're doing a service by everybody being able to, uh, create that plan of care in a more efficient manner and check in with them as well as opening the door for more evals.
So I think that that's really valuable,
Bryan: that that is also, I think, a good thing to discuss. Discuss for high deductible plans. You know, I actually think that our TM is probably a great, a great thing for those. If the therapist says, you know. Normally I would see you twice a week for four weeks on here.
But if we include the remote care navigator in here, the biggest thing is that we're really consistent with the program. And if they're part of it, we can probably drop this down to once a week. Uh, we can, we can kind of, I'm, I'm hearing you about the expenses, but we can actually help accommodate that.
It's a good message.
Marla: Yep. And I know lots of people wanna know about results. So what actually are the, is the financial impact you have seen from RTM and Mary Rose? I'll start with you.
Mary Rose: Sure. So for us with the full service model, um, it's easy to evaluate. We look at what's the percentage we're paying for the full service versus what's the percentage that we expect to then, um, bring in in our collections.
And I can tell you we are seeing a complete return on our investment with this. So it's made it, um, you know, part of the reason I'm here today. It's part of the reason I'm, I am, you know, very excited and passionate about where this is going is not, not only is it enhancing our practice and allowing for better care, allowing for us to stay connected with our patients and, and move into the, the new strategy of where our private practice is going.
But, um, it's doing so in a way that we are seeing the return on investment. And as a practice owner, it's not sucking up all my time. I mean, that's a big thing too, is, you know, there's opportunity and time costs to these different programs that you implement. And, um, again, for us why the full service was, was definitely worth it.
But we are seeing the, the full return that I was told we would, we are seeing it, which is excellent.
Marla: Can anyone give us some numbers in terms of increased adherence or plan of care completion or any of those metrics from a quality or a quantitative perspective?
Vikram: Yeah, so, so the one I mentioned, um, from the internal study that we did was, um.
5.5 average visits per plan of care increased for RTM versus non RTM patients. And that's not just that some people who would've dropped off with that average, with that increased engagement are ending up completing their plans of care, but also those additional check-ins that that remote provider is doing in between visits.
Sometimes we'll just remind the patient they have a visit the next day and then they don't, uh, miss their visit. And then that can be the difference as well. So there's lots of advantages to those extra touchpoint. Um, some other studies from, um, the field, from, from the industry, from the space on adherence, 15 to 40% increase for RTM patients versus non RTM patients and 57% improvement in adherence from another study, uh, which is more tailored around measuring drop off.
So there's lots of stats on this. Like I said, we're gonna be sending out that one pager that has a breakdown of all the studies, um, to motivate, you know, anybody to to see the, see the light, see the value in RTM more than just the dollars that come in from the CPT codes being billed.
Marla: , what about you?
Any subjective or objective results that you've seen in your clinic or in other clinics that you've been managing?
Bryan: Um, I think one of the things that these were, everything was, I agree with all those that were already mentioned. I think one thing I wasn't expecting was, um, uh, home exercise programs that, you know, as, as owners, like we don't have time to look and see is every single patient getting a home exercise program or not?
Like we don't have that micromanagement ability. Um, but for the remote care navigating world, like we have to have the patient have access to the FDA compliant, uh, app and they have to have a home exercise program to do that. So what I've kind of seen is that there are a lot of people who don't get a home exercise program, and on top of that, if they do, we can also see when it was last updated.
If it's been six weeks since anything has been updated, no additional sets, nothing. What that actually ends up doing subtly is like driving our, driving us up a little bit in terms of what we're providing as a value. Um, which is just exciting to me again, um, because that makes our in-clinic experience even better too.
Marla: Uh, absolutely. Uh, that is spot on and I think that's a really great value add to understand, because I don't wanna say PTs don't have time to do that, but this prioritizes the time to do that. And then your remote therapeutic monitoring can check in and make sure that those exercises have been updated.
'cause a lot of times, again, that does get forgotten and if we value our plan of cares and we do want them to be doing that at home, we have to make sure they're communicating and seeing that same um, plan that we provided to them. Especially with those Medicare patients. Um, and with that, I'd also, Mary Rose, if you have some input onto why you feel that the actual tool and technology that you utilize provides good results in general.
So the difference of a tool that may not be fully integrated in your system, um, your billing, your, uh, processes, and one that is, and how that makes a big impact from you, seeing both of those tools being done in your own clinic.
Mary Rose: Absolutely. Um, again, I think it's compliance. It's compliance on the side of your providers When you have a tool that it's one click in your documentation and you're able to, you know, get right into the screen, um, that all of the patient information's already added.
So when you go from prompt to the, um, engage platform, you're not having to reenter that patient. Everything's just right there. So very, very easy to get over there. It's very easy to copy what you're doing and then put it right back into prompt so that those systems can always be up to date and, and working together.
And then on the billing end, it's a similar thing. So, um, PROMPT has backend rules that it can, you know, hold a certain, and this is again, just how we're doing it. I know Vikram mentioned there's so many different ways, and it might be different for other people, but, um, through the, the ability to create these backend rules and have these systems.
It's been just completely seamless for us. Um, so that's been the huge advantage of having a tool that's, you know, well integrated and communicates. Um, you know, well is you're not spending your time as a provider or as a biller trying to make this all go. You can just leverage what's already there and, and then spend time, you know, like had said, actually updating your program, actually making sure your patient is engaged with it, um, and, and prioritize more important things.
Marla: I'd take one step further and say, if your providers aren't writing tons of notes at home, so you have an EMR scribing tool that allows them to get that done quick and fast, then they can focus on these extra pieces like the home exercise program, the RTM, uh, allow that time and space and even allow time for a new eval, like we said, to really manage it at a higher level.
So, um, really great feedback. And we have a ton of questions, so I wanna make sure I leave a lot of time for that. Um, let me see. We've got a few, and this we did touch on a little bit. Just wanna explicitly say, uh, does RTM increase the patient's out-of-pocket expenses?
Bryan: I, I would, this goes back to it depends.
And when it comes back to it depends. It means say that it will and own that it, it will, and that it's a value. I, I know that sounds too simple, but it really will help address the whole thing as it gets more and more complex with different insurances and how they pay.
Marla: Great, great answer.
Mary Rose: And to add to that, with your providers, if you tell them, this is part of what we do, it's not an option, it's not an option for my providers to say, I wanna do manual therapy, but I don't wanna do therapeutic exercise.
Like, we don't talk through those options with the patient. So like said, this is what we do and this is how we can provide value and this is just a part of it and you package it that way.
Marla: Great. And then we have a question asking, what about pediatric outpatient settings? Is there anything different for this type of a clinic?
Bryan: That's a really good question. Uh, there, there is some nuances with that. Um, it. It's not utilized very often in my experience so far, in, in terms of not, not that it's, uh, necessarily a problem, I just haven't seen it happen very often. Uh, some of that probably has to do with the payers who are paying, um, because Medicare started this, and you can have individuals who are on Medicare, but, uh, oftentimes it's another insurance.
Uh, there's just a few new more nuances that you have to go into to understand like, what are their, are they covering RTM codes in the first place, and how do they cover them? Um, but in essence, if they are covering RTM codes as an allowed amount, then the whole rule stay the same. The, the parent would be the one who would be the prob, well, depending on the, the child's age, but, um, the one who's communicating and making sure that the program is being completed, uh, between visits, but it's still, it still could happen.
Marla: Great, thank you and this is a great one from Rick Douglas asking, um, he is evaluating RTM and considering scaling it, but he wants to know how others are tracking costs, including opportunity costs in general, tracking revenue per unique patient and revenue per unique eligible patient, but having a difficult time tracking opportunity costs.
Any suggestions there?
Vikram: Yeah, I mean obviously we alluded to a couple times that other stats, the other metrics which benefit a clinic in addition to just the, the raw revenue number that you have for, for RTM. Um, that's, of course not to say anything about the subject subjective side. Maybe Mary Rose or can speak to a little bit more about, um, you know, the patient experiences and, and kind of feedback from them on having that extra layer of support, having those extra check-ins.
But, um, plan of care length for RTM versus non RTM patient, um, drop-off rate for R TM versus non RTM patient. Um, those are some other stats to look at when you're kind of evaluating ROI for, for implementing RTM.
Marla: Yeah, I love that plan of care completion. Absolutely. Self dc are they discharging themselves?
Are they actually being discharged by the PT and their plan of care? Um, great. Well this one from Michael is about a patient going outta town for two months. Can we keep up with RTM and build that without a physical visit? So there's actually two questions to this. 'cause One is that he's outta town and the other is to keep up with RTM.
Vikram: Yeah. So, so yes you can. Um, as far as billing as a whole, I'll kind of touch on this for a second. In terms, I've seen a couple questions on, do we build this as part of an actual visit? Do we create like a, a separate RTM visit to build this, um, in, in 's words, it depends. And part of, you know, what we wanna do is we wanna be a resource on this because it, it is very tricky, especially like when you're getting commercial payers involved to bill RTM.
Um, to give some examples, you know, you may have a plan where you have a flat four unit cap on the per visit. Then people will often think, okay, I can't attach my RTM codes to that because they're not gonna get paid because that'll be more than four units. But then we're seeing RTM codes for, for plans like that, getting paid on top of the four units because those are monitoring services and not therapy services.
So there's, there's a lot of nuance here. Uh, we have access to a lot of data on, um, different claim on all claims submitted and for different payers. And we can be a resource, we can be a guide for this. Ultimately, at the end of the day, you're gonna need to try billing the codes or contacting the payers to, to really see for the commercial side, um, you know, how this is, uh, you know, what your specific situation will be.
Um, but to circle this all the way back to the actual question, in this case, obviously you would need to create a RTM visit to submit those codes because that patient wouldn't have come in that month. Um, so you would need to basically create an RTM visit to attach the codes in that case.
Marla: So yes, that way.
And then you do need to make sure you're licensed in the state that they are traveling to
Vikram: correct. Yeah, exactly.
Marla: Great. Um, and then how are you addressing patient responsibility for RTAM? Are you having info in the intake paperwork addressing during discussions or, um, just telling all about RTM is, how are you explaining that to the patient?
Vikram: I know will take this one.
Bryan: Just, just all the above. I mean, I mean, it is all the above. You do it in the intake. You talk about the value and, and, and, uh, why you're, why you're doing it. You talk about the patient responsibility that they could see something. Um, and this is kind of what the, the range can be.
Um, you just get really ahead of it and, and you say it again and again.
Marla: Perfect. Perfect. Uh, we say you need seven touch points for somebody to actually hear you, so that's accurate. Um, we're gonna keep answering questions, but. I wanna put up a quick poll as before, so making sure nobody leaves yet. Um, if you do wanna learn more and you wanna learn more about Prompt in the EMR, if you wanna learn about Prompt Engage, which is also formerly known as PT Wired or you wanna learn more about , his clinic and Tandem RTM or Mary Rose and New Life pt, um, please feel free to indicate that so that we can make sure to give you the correct services and follow up with you afterwards.
Alright, great. So as that up, I'm gonna keep answering these questions. This is a one about the new codes. Is it correct that the updating of exercises, reading the patient's feedback and monitoring the patient's performance would fall under the 9 8 9 8 5 and 9 8 9 7 7 codes?
Vikram: No. So I, I think that was a bit of a con, a mixture of the different requirements.
So the, the different activities that were listed there are. The time-based activities that would count towards 7, 9, 8, 0, and eight one, um, for 9, 8, 9, 8 5 and 9, 8, 9, 7, 7. Those are based on the data transmission readings. Um, so that's based on the patient's, uh, activity on the device and the device's collection of data.
Marla: Great. And that one slide that you sent out, will, that you showed earlier, we we'll put in our email follow up as well, right?
Vikram: Yeah, absolutely.
Marla: Um, do you have resources for full service companies that terrific?
Vikram: Yeah. Well, we have, we have one on the call, which is tandem, RTM, Lang here. That's, uh, if you're a prompts group, that's the, the one that we are currently working with.
So, um, yeah, I'm not sure if, uh, you can, can they see 's contact on here? Or maybe it could be that you could put in the chat,
Marla: right. If, if they, or. If they clicked interest in , then will absolutely follow up.
Vikram: Perfect.
Marla: Great. Um, then this one, is it just Medicare or Medicaid? Do they do it as well
for rtms?
Bryan: I'll hit it. I'll, I'll hit on this. Uh, depends. It's, it depends on the, on the, on the, who is the, uh, insurance that is supplying the coverage for Medicaid in the region. Um, there are blanket statements that are just, no. And then there's other, uh, insurances where they actually are covering it, though there are some nuances to that just in terms of, we like to look at what are they paying, like how much are they paying?
Is this still a value for us, um, from a financial perspective? Um, but I hate the answer. It depends, but there's a lot of, it depends based on the region that you're working from and who the payer is.
Marla: Great, thank you. Um, and then I'm gonna take this one, is anyone implementing a cash based service or model with RTM?
Mary Rose: I'm not do doing this yet for cash pay, but we're definitely exploring it as we're looking at, you know, what potential membership models look like. Being able to have like asynchronous communications and way of, of continuously staying in touch with patients is huge. And that's exactly what this is setting us up for.
So we're not there yet, but we're definitely exploring it.
Bryan: I've seen some already. We're also exploring it too. Um, it seems like a, it seems like a nice easy road into, uh, cash pay practices, uh, even in the, in the sense of, um, RTM happens when a patient has a plan of care. Right when a patient's discharged, you know, now all of a sudden we have to conclude our tm.
And if the discussion is like, Hey, if you want to keep going with having somebody check in with you, just to kind of keep everything going the way we had this planned, uh, we do offer this as a cash pay service. It's this amount. Um, you can take it if you want to. It's a really, really gentle way to do it.
Marla: Great. Great. And we, as we said, we have a lot more questions. We will follow up with all of them, um, after this call. So thank you so much. But really, if there's one takeaway from today's conversation, it's that RTM is not just a billing strategy, it's a care delivery strategy. And the clinics that succeed with RTM are not the ones that are just implementing as a technology and an add-on.
They're the ones intentionally redesigning workflows, aligning their teams and embedding RTM into their existing. Systems and how they deliver care. And as healthcare shift happens towards more longitudinal outcomes driven models, RTM will be a foundational component of modern practice and not an optional one.
I truly believe that. And hopefully you've heard that from and you've heard that from Mary Rose. Um, and really wanna thank all of our panelists today. Your information is invaluable and your time to be here to help everybody. Um, we appreciate it and we thank you for joining us. And as I said, we will share all the resources and follow up materials after this webinar.
And we hope this conversation has really helped you think differently about RTM and can help you enable it inside your organization. And we're here for you in case you need us. So thank you so much. Appreciate you all jumping on today. Till next time.
