Remote Therapeutic Monitoring (RTM): Expanding Care Beyond the Clinic

Introduction: The New Frontier in Value-Based Care

Managing chronic conditions like musculoskeletal pain, respiratory issues, or behavioral health concerns doesn’t always require a clinic visit. For Federally Qualified Health Centers (FQHCs), this presents an opportunity—and a challenge. How can providers continue supporting patients in between visits while staying reimbursed and resource-efficient?

Remote Therapeutic Monitoring (RTM) offers a solution. Enabled by digital tools and guided by CMS billing codes introduced in 2022, RTM allows clinicians to track patients’ symptoms, therapy adherence, and outcomes in real time, outside the traditional clinical setting.

Unlike Remote Patient Monitoring (RPM), which focuses on physiological data like blood pressure or glucose, RTM targets therapy-related data such as pain levels, medication adherence, and functional status. This makes RTM ideal for physical therapy, pain management, and behavioral health—areas with high patient need in underserved communities.

For FQHCs, the benefits are threefold:

• Improved patient outcomes through timely intervention and education
  
  
• Expanded access to care for homebound or remote patients
  
  
• New reimbursement pathways to support virtual care models
  
  

As healthcare shifts toward preventive, patient-centered models, RTM becomes a powerful tool to extend care beyond clinic walls, close gaps in treatment, and keep patients engaged in their recovery journey.

1: Process – Building a Sustainable RTM Workflow

Identifying the Right Use Cases

To implement RTM successfully, FQHCs must first identify where it fits best in their care model. RTM is especially useful for:

• Musculoskeletal disorders (MSK): Monitoring pain scores and therapy exercises
  
  
• Behavioral health: Tracking anxiety, mood, or therapy compliance
  
  
• Respiratory illnesses: Logging inhaler use or symptom changes
  
  

Start Small: Launch with a pilot group (e.g., chronic back pain patients or post-discharge therapy patients) and refine based on patient feedback and clinician workflows.

Document What Counts: CMS requires RTM data to be digitally collected and reviewed by a qualified healthcare professional. Use structured questionnaires or apps that automatically log patient entries and meet documentation requirements.

Care Team Involvement

RTM can’t function in isolation. It requires collaboration across:

• Providers: Order and oversee RTM services
  
  
• Nurses/medical assistants: Support onboarding and patient education
  
  
• Billing teams: Ensure accurate CPT coding and documentation
  
  

CPT Codes for RTM:

• 98975 – Setup and patient education
  
  
• 98976/98977 – Device supply for respiratory/MSK monitoring
  
  
• 98980/98981 – 20+ minutes of provider time reviewing RTM data
  
  

Tip: Use EHR alerts to track when 20-minute thresholds are met for monthly billing.

2: Product – Choosing the Right RTM Technology

What Makes RTM Different from RPM Tools?

RTM software must collect non-physiological data such as:

• Pain levels (rated by the patient)
  
  
• Medication adherence
  
  
• Exercise or therapy engagement
  
  
• Self-reported symptoms (fatigue, stiffness, shortness of breath)
  
  

Unlike RPM, data may be patient-reported rather than device-captured, but it must still be collected via a connected platform (not just paper or verbal updates).

Look for Platforms That Offer:

• Easy mobile interfaces for low-literacy patients
  
  
• CMS-aligned data collection and reporting
  
  
• Spanish language support or multilingual options
  
  
• Integration with EHR or exportable reports for billing
  
  

Top Vendors in the RTM Space:

• Hinge Health – MSK-specific tools with outcomes data
  
  
• Limber Health – PT-focused platform used in FQHC settings
  
  
• Plethy Recupe – Device-enabled monitoring for home exercises
  
  
• HealthSnap – Broader RTM/RPM integration with clinical dashboards
  
  

Real-World Benefit: A Florida FQHC using Limber Health saw 30% higher physical therapy compliance among patients enrolled in RTM vs. traditional care.

3: People – Training Teams and Engaging Patients

Staff Training Drives Success

RTM requires a shift in thinking. Clinicians and care managers must learn how to:

• Interpret patient-reported data remotely
  
  
• Engage patients proactively when flags appear (e.g., increased pain or missed sessions)
  
  
• Document interactions for compliance and billing
  
  

Training Checklist:

• CPT coding and billing compliance
  
  
• Using dashboards to identify at-risk patients
  
  
• Scripts for patient engagement (“We noticed your pain scores increased last week…”)
  
  

Some FQHCs designate a "virtual care navigator" to manage RTM patients and act as a bridge between provider and patient. This helps streamline coordination and improve outcomes.

Patient Engagement is Key

RTM works only if patients consistently report their data. This requires:

• Simple apps with reminder features and clear instructions
  
  
• Frequent encouragement from care teams (especially early on)
  
  
• Language and accessibility support
  
  

Tip: Provide visual pain scales, tutorial videos, and brief training sessions during in-clinic visits or virtual onboarding.

Patient Feedback Example: At a community clinic in Texas, 74% of RTM patients reported that logging their symptoms weekly helped them better understand their condition—and they were more likely to adhere to prescribed exercises.

4: Real-World Examples – How FQHCs Are Using RTM Today

Case Study 1: Bronx Community Health Network (NYC)
This FQHC integrated RTM into their pain management program using Plethy Recupe. Physical therapists could track home exercise completion and pain trends. In six months, patients using RTM reported 35% faster pain relief compared to standard therapy.

Case Study 2: Open Door Community Health Centers (California)
Serving rural patients with limited in-person access, Open Door rolled out RTM for asthma management. Patients used an app to log inhaler use and symptoms daily. As a result, they reported a 40% decrease in emergency visits related to respiratory distress.

Case Study 3: Salud Family Health (Colorado)
In a pilot RTM program for behavioral health, Salud tracked mood and therapy engagement for patients in counseling. When patients showed declining engagement or rising distress, clinicians intervened early—leading to a 20% increase in therapy session attendance.

Conclusion: RTM Brings High-Touch Care to Low-Access Settings

FQHCs are built to reach the patients who need care most—and RTM strengthens that mission. By monitoring therapeutic progress in real time, clinicians can close the care gap between visits, engage patients more meaningfully, and prevent complications.

RTM isn’t just about new technology—it’s about changing the way care is delivered. Instead of reactive treatment, clinics can proactively track recovery and offer timely support. For chronic pain, behavioral health, or respiratory conditions, this can mean the difference between getting better and getting worse.

Financially, RTM opens new reimbursement pathways that help FQHCs sustain their mission without burdening clinicians. CMS has recognized the value of virtual care beyond vitals—and now offers codes that reward thoughtful, consistent patient engagement.

The future of healthcare is not just digital—it’s data-driven, human-centered, and home-supported. Remote Therapeutic Monitoring is one of the most powerful tools available today to help FQHCs meet that future with confidence.

Ready to extend your care beyond the clinic?
Start with one condition, one provider, and one pilot program.
Train your team, choose your RTM platform, and start tracking what matters—your patients’ recovery.
Remote care doesn’t mean distant care. RTM brings it home.

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