Excuse Me, You Dropped Your Wallet: Is Your RPM Program Working for Your Practice—or Against It?
- Martha Duarte
- Jul 9
- 8 min read
Somewhere in your practice right now, there’s a reading that was transmitted at 2 am and sat in a portal unnoticed until someone had a rare moment of free time to check it.
That same gap that puts patients at risk is quietly draining six figures from your practice every year. Running a Remote Patient Monitoring (RPM) program in-house makes complete sense, in theory: you already have staff and patients accounted for, so why not just manage the program within your own practice with your own team? Wouldn’t that end up saving you money?
In theory, running RPM within your practice means you don’t have to share any of the revenue with extra staff or another team. The truth is, in the long run, you’d be losing more money than you’d be making. Running RPM in-house may work at a lower cost for a while... Until notifications and alerts go unanswered because there are not enough hours in a workday, billing is delayed because of missing documentation, transmission logs stay unfinished, and your clinical staff burns out from the accumulated workload.
So, instead of dedicating more time to your patients, your practice struggles to maintain its usual clinical workflow while managing the device and logistics the program demands.
RPM is not a difficult program to start or maintain. The deciding factor is whether your practice can retain patients and uphold high-quality documentation at full capacity. That ability can be hindered when you already have your hands full, limiting the additional revenue that the program brings into your practice.
What In-House RPM Really Looks Like
When a practice decides to run RPM internally, the program may run well at first with a manageable patient list and basic operational systems in place. Devices are ordered on time, clinical staff is assigned to review readings, and progress is tracked smoothly for the first few months. But what happens when your staff takes leave, or if the patient panel grows? Perhaps the device vendor decides to change prices, there is a glitch in the portal interface, or busy staff don’t notice when a patient's data stops transmitting.
RPM has specific operation requirements. For example, CPT code 99454 requires at least 16 days of data transmission within a window of 30 days. While 2026’s new 99445 lowers the threshold to 2 days, it adds a new tracking requirement: which tier does each patient fall into each month? Additionally, code 99457 requires at least 20 minutes of documented communication with the patient and treatment services management in the same timeframe.
However, the new 99470 code covers a shorter 10-minute threshold for patients with lower-engagement, so again, staff is tasked to track and assign the right code for each patient every month (Godla, 2026).
The turning point comes when a third-party collaborator monitors these requirements. Results become constant, unlike when the program is monitored by in-house staff, who still must manage in-office visits, prior authorizations, and documentation. RPM programs require consistent outreach, patient engagement, documentation, and escalation management, which often strain short-staffed clinical teams as patient enrollment grows (Siwicki, 2026).
Managing incoming RPM data has been described as burdensome and difficult to integrate into existing workflows for primary care practices whose main patient pool comes from in-person visits; this burden has also been linked to physician burnout (Hailu, 2024). This is the point where most practices question whether RPM is worth running and starts being whether your practice is the right one to run it, or whether a partner like Enable Healthcare should.
The Opportunity Cost of Keeping RPM In-House
It is easy to underestimate the cost of running RPM internally because it is spread across staff time that is difficult to measure or attribute entirely to the program.
Realistically, the program needs staff available to review daily transmissions. Staff also need time to manage alert thresholds, escalate outlier readings, verify compliance with minimal transmission requirements for each patient, and follow up with patients who are not meeting these requirements. In addition to these daily tasks, documentation needs to be appropriately recorded in an audit-ready format. Because billing must be reconciled at the end of every month, patients who do not meet the minimum documentation requirements need to be monitored and followed up to ensure proper billing.
A practice with a panel of 40 patients may spread their weekly workload across just 2 or 3 staff members. However, with a larger panel of 200 patients, the additional workload requires an extra hire just to keep up with the management responsibilities that come with a growing patient panel.
Nonetheless, this additional role may fall short of adequately meeting all of the program requirements. A practice with 100 RPM patients has roughly $125,000 in annual revenue available with just codes 99454 and 99457. The difference between what a practice bills and what it could bill usually presents as both a staffing and workflow problem and a patient panel issue. Practices considering running RPM internally should also consider the substantial investment required for staff training, workflow development, recruitment or reassignment of licensed clinical staff, RPM-specific billing training, and technology build-out and deployment. The fixed costs of running this program internally may not be as justifiable for smaller-volume patients, given the substantial investment of resources required to run them (Longyear, 2025).
The result is not a program that crashes when it first starts; rather, it performs poorly at the cost of the clinic’s wallet and the health of the patients who fall through the cracks. Patients who should have been followed up on because of a missed reading could snowball into a missed financial opportunity, with only 70% of billing properly submitted instead of 90%. Revenue could still be coming in, just not on a level comparable to what the practice’s enrolled patient panel could generate.
What Happens when Enable Healthcare Runs RPM
When Enable Healthcare takes over the logistical burden, you no longer have to worry about the administrative workflow behind the program. Alert management, transmission monitoring, follow-up, and billing documentation become our responsibilities. With a care coordination team of Licensed Nurse Practitioners and Certified Medical Assistants purpose-built for RPM, we have the infrastructure in place to take the operational weight off the practice while driving profitable revenue and patient retention in the program. Meanwhile, the practice maintains full clinical supervision. All escalated issues are reviewed by providers, and all clinical decisions are made by providers.
This is especially important with regard to 3 common problem areas for programs run in-house:
Alert response: If a patient’s blood glucose reading crosses a threshold at 8 am on a Monday, someone needs to be available to respond within an appropriate clinical timeframe. This may be assigned to a clinic’s staff who already have many other responsibilities. With Enable Healthcare, our dedicated clinical team is responsible for responding to these alerts and escalating the issue directly to the practice. It’s also important to consider that before an alert can even be responded to, the data has to transmit. With Enable Healthcare, our GSM-enabled devices do not require Wi-Fi access, a smartphone or app to pair with the device, or manual uploads. This makes it more accessible to patients who face technological or financial burdens and removes one of the main reasons in-house RPM programs lose readings before they ever reach a clinician.
Transmission compliance: Enable Healthcare’s proactive outreach monitors transmission cadence for each patient and reaches out to those who are falling behind before the 30-day billing window closes— not after, when it’s already too late. Compliance experts recommend intervening before the end of the billing period to address common troubleshooting issues such as hardware replacement, device pairing, and managing patient expectations to create a buffer before this critical period is met (Intelligence Factory, n.d). Practices that deploy devices with Enable Healthcare’s model achieve a 70% transmission compliance rate, a milestone rarely sustained by in-house programs once the panel size grows beyond what staff can track manually.
Documentation for billing: Federal oversight by organizations such as CMS, OIG, and DOJ closely monitors RPM and auditing claims in 2026 to confirm medical necessity as well as accurate coding and billing. CPT codes 99457 and 99458 require documented communication, clinical review, and time attribution allowable under audit. Noncompliance may result in penalties, fraud investigations, and reimbursement demands (McGovern Medical School, 2026). Enable Healthcare’s platform integrates documentation directly into our EMR by automatically generating structured encounter notes for every interaction (capturing readings reviewed, time spent, and patient communication). Our team then validates it against transmission data prior to claim submission. The practice never has to deal with documentation gaps at the end of every month because they don’t happen in the first place.
The Real Comparison
Practices evaluating the pros and cons of running RPM in-house or with Enable Healthcare are primarily considering cost, and they are ultimately deciding between two different versions of the same program: one that oversaturates staff capacity and one that runs on intentionally designed infrastructure.
A practice with a patient panel of 40 RPM patients in-house and a practice with 200 RPM patients via Enable Healthcare do not perform the same tasks at these different patient population sizes. They are essentially running two different programs. The former is an add-on to their existing workflow; the latter is a clinical service working together with them.
You can see the difference in the ease of patient enrollment, response rates to alerts, the consistency and accuracy of billing, and, most importantly, patients' health outcomes. Patients with chronic diseases who are actively monitored and contacted at reliable intervals have more favorable outcomes than patients whose transmitted data ends up in a portal that no one has time to check.
Two Truths and a Lie
Truth: Your patients need monitoring that continues beyond normal business hours.
Truth: Your staff is already at capacity most days.
Lie: The only way to run RPM is by doing it all yourself.
Enable Healthcare’s RPM program is not a substitute for your care team. The difference lies in the available infrastructure that gives your care team the time and space to focus on clinical and patient-related tasks without spending half their day managing device logistics and transmission logs. Studies have found that staff are often overwhelmed with non-clinical tasks that consume most of the day’s work (e.g., charting, responding to messages, and prior authorizations) (Habib et al., 2025).
The potential patient panel exists already. The revenue potential is already there. What’s been missing is a program to capture both at any scale, consistently and compliantly. This gap only grows in 2026. CMS expanded RPM eligibility to include GLP-1 patients, post-operative recovery patients, and behavioral health patients, while also adding new codes that lower the transmission and treatment services management time requirements for billing. That means that, based on these updates, the addressable patient panel in most practices has grown significantly. This entails more complexity to manage, more compliance to track, and more revenue to either take hold of or leave behind.
To see what RPM looks like running at full capacity for your practice, visit our home page to book a demo with the Enable Healthcare team today.
References:
Godla, D. (2026, March 25). 2026 Remote Patient Monitoring CPT codes: 99470, 99457, 99453 and more. ThoroughCare. https://www.thoroughcare.net/blog/remote-patient-monitoring-billing-rules
Habib, A., Ansar, W., Khan, H. R., Bashir, T., & Muhammad, N. (2025, November). Burnout and Well-being of Medical Doctors: Global Trends, Causes, and Interventions. Multidisciplinary Surgical Research Annals. https://www.researchgate.net/publication/397781591_Burnout_and_Well-being_of_Medical_Doctors_Global_Trends_Causes_and_Interventions
Hailu, R., Sousa, J., Tang, M., Mehrotra, A., & Uscher-Pines, L. (2024, April 23). Challenges and facilitators in implementing remote patient monitoring programs in primary care - Journal of General Internal Medicine. SpringerLink. https://link.springer.com/article/10.1007/s11606-023-08557-x#citeas
Intelligence Factory. (n.d.). Remote Patient Monitoring (RPM) guide (2026 rules). FairPath. https://fairpath.ai/resources/rpm-guide
Longyear, R. (2025, December 19). A 2026 guide to Operationalizing A Remote Patient Monitoring Program. A 2026 Guide to Operationalizing a Remote Patient Monitoring Program. https://longyearhealth.substack.com/p/a-2026-guide-to-operationalizing
McGovern Medical School. (2026, January 20). Remote Patient Monitoring (RPM). Medical School Healthcare Billing Compliance. https://med.uth.edu/mshbc/digital-health-services/remote-patient-monitoring-rpm/
Siwicki, B. (2026, May 26). Remote patient monitoring faces a reality check | healthcare IT news. Healthcare IT News. https://www.healthcareitnews.com/news/remote-patient-monitoring-faces-reality-check
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