CPC Telehealth and Remote Patient Monitoring 2 — Questions and Answers
Question 1: Which of the following BEST describes 'asynchronous telehealth' (store-and-forward)?
- Real-time video visit between patient and provider
- Transmission of patient data, images, or clinical information to a provider for review at a later time (Correct answer)
- Remote patient monitoring with real-time alerts
- Telephone consultation without video capability
Correct answer: Transmission of patient data, images, or clinical information to a provider for review at a later time
Asynchronous (store-and-forward) telehealth involves collecting patient data (photos, videos, test results) and transmitting it to a provider for review and response at a later time — without real-time interaction.
Telehealth modalities: Synchronous (real-time): live video or audio interaction between patient and provider (telemedicine visits, triage calls). Asynchronous (store-and-forward): patient data — wound photos, ECG tracings, retinal images, questionnaire responses — transmitted for later provider review and response. Remote Patient Monitoring (RPM): continuous or periodic collection and transmission of physiological data via connected devices. mHealth (mobile health): use of smartphone apps and SMS for health education, monitoring, and communication. In community paramedicine, asynchronous telehealth is used to transmit wound photos to dermatologists/wound care specialists or 12-lead ECG tracings to cardiologists for interpretation between home visits.
Question 2: A community paramedic is setting up a patient for a remote patient monitoring program. Which step is MANDATORY before enrolling a patient?
- Verifying the patient has a smartphone
- Obtaining written informed consent from the patient documenting understanding of RPM purpose, data use, and privacy (Correct answer)
- Confirming the patient has broadband internet
- Completing a 30-minute technology literacy assessment
Correct answer: Obtaining written informed consent from the patient documenting understanding of RPM purpose, data use, and privacy
Written informed consent is a mandatory legal and ethical requirement for RPM enrollment, documenting that the patient understands what data will be collected, how it will be used, who will have access, and their right to withdraw.
RPM informed consent must include: (1) description of the monitoring program and devices; (2) what data will be collected and transmission frequency; (3) who will review data and response time frames; (4) privacy and security protections for PHI; (5) alert thresholds and what happens when they are triggered; (6) costs/copays; (7) right to withdraw at any time without affecting care. Smartphone ownership and internet access are desirable but not absolute requirements (cellular-connected devices may be provided). Technology literacy assessment is helpful but not mandatory. The CMS RPM billing guidelines also require patient consent documentation for reimbursement. Community paramedics document consent in the EHR before device distribution.
Question 3: Which of the following represents an appropriate use of telehealth in the community paramedicine treat-and-refer model?
- A community paramedic diagnoses and prescribes antibiotics for a patient with suspected pneumonia via telehealth without physician involvement
- A community paramedic conducts a video-assisted physical assessment with a supervising physician who then provides orders for home-based treatment (Correct answer)
- Using telehealth to avoid all patient in-person contact regardless of acuity
- Conducting telehealth visits without documenting the encounter in the EHR
Correct answer: A community paramedic conducts a video-assisted physical assessment with a supervising physician who then provides orders for home-based treatment
In the treat-and-refer model, community paramedics use telehealth to connect patients with supervising physicians in real time, extending the medical director's oversight into the home setting and enabling evidence-based treatment orders without unnecessary transport.
The treat-and-refer (or treat-in-place) model allows community paramedics to assess patients at home and, through telehealth connection to supervising physicians, treat conditions that do not require emergency transport. Examples: suspected UTI managed with physician-directed antibiotic order via standing protocol, wound management with real-time dermatology consultation, CHF exacerbation management with cardiologist-directed diuretic adjustment. This model requires: collaborative practice agreement or medical director standing orders, HIPAA-compliant telehealth platform, documentation in the EHR, and defined escalation criteria for transport. The CP never diagnoses or prescribes independently — physician oversight through telehealth maintains the legal and clinical safety framework.
Question 4: Digital health literacy involves a patient's ability to:
- Purchase the most advanced smartphone model available
- Find, evaluate, and apply health information accessed through digital technologies to health decisions (Correct answer)
- Use social media platforms for general communication
- Navigate electronic health record patient portals without assistance
Correct answer: Find, evaluate, and apply health information accessed through digital technologies to health decisions
Digital health literacy encompasses the ability to seek, find, understand, and appraise health information from digital sources — and to apply that knowledge to health behavior and decisions, not just the ability to use technology.
The Norman and Skinner (2006) eHealth literacy model (eHEALS) defines digital health literacy as the ability to: (1) use electronic tools; (2) find health information online; (3) evaluate the quality and credibility of health information; (4) apply digital health information to health decisions. It encompasses six literacies: traditional (print), information, media, computer, science, and health. In community paramedicine, digital health literacy assessment is necessary before recommending RPM apps, patient portal use, or online symptom checkers. Low digital health literacy increases the risk of misinformation, self-medication errors, and telehealth disengagement.
Question 5: Under the current CMS Remote Patient Monitoring billing rules, CPT code 99454 requires a minimum of how many days of data transmission per billing period?
- 7 days
- 10 days
- 16 days (Correct answer)
- 30 days
Correct answer: 16 days
CPT 99454 (device supply and daily transmissions/recordings, 30-day period) requires at least 16 days of data collection and transmission within the 30-day billing period to bill the code.
CMS billing requirements for RPM (effective 2022 Physician Fee Schedule): CPT 99453: One-time device setup and patient education — billed once per monitoring episode; CPT 99454: Device supply/daily data transmission — requires ≥16 days of readings in a 30-day period (~$65/month); CPT 99457: 20 minutes of clinical staff time reviewing data and communicating with patient — requires interactive communication at least once per month; CPT 99458: Additional 20-minute increments. The 16-day minimum prevents billing for minimal patient engagement. Community paramedicine programs must track compliance days and patient engagement to ensure billing integrity and document the required interactive communication per 99457.
Question 6: Which of the following telehealth modalities is MOST appropriate for a post-discharge community paramedicine patient who is hearing impaired?
- Standard telephone audio call only
- Asynchronous text/image messaging only
- Video telehealth with captioning, sign language interpreter, or real-time text relay services (Correct answer)
- No telehealth — in-person visits only for all hearing-impaired patients
Correct answer: Video telehealth with captioning, sign language interpreter, or real-time text relay services
Patients with hearing impairments have the right to effective communication under the ADA and Section 504 of the Rehabilitation Act. Video telehealth with captioning, sign language interpretation, or real-time text enables effective clinical communication.
The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act require healthcare providers to provide effective communication for patients with disabilities, including hearing impairments. For telehealth, accommodations include: automatic captioning (built into platforms like Zoom for Healthcare), qualified sign language interpreters via video relay interpreting (VRI) services, real-time text (RTT) relay, or text-based communication for deaf patients who prefer it. Standard telephone audio calls without captioning are inadequate for many hearing-impaired patients. Community paramedicine programs must have documented language and disability access plans that include telehealth accessibility accommodations.
CPC Telehealth and Remote Patient Monitoring 2
Which of the following BEST describes 'asynchronous telehealth' (store-and-forward)?