Remote patient monitoring
How Caesar runs RPM alerting
Patient texts ask for an action and never carry the reading. Staff alerts put a named task in front of a named person. Two clocks per patient keep the 16-day count and the monthly live call on track.
RPM alert management is the set of rules that decides what happens after a remote reading arrives: a text to the patient, a task for the clinic's staff, or nothing at all. Caesar Health runs it on two rules. Patient texts ask for an action and never carry the reading. A person on the clinic's staff makes every clinical call.
Two audiences, two kinds of message
The patient and the care team need different things from the same reading.
| Patient texts | Staff alerts | |
|---|---|---|
| Purpose | Change one behavior: retake, take a reading today, reply, or call 911 | Put a named task in front of a named person |
| Carries the reading value | Never | Yes, on the chart and the review queue |
| Interprets the result | Never | The clinician does |
| Timing | 08:00 to 20:00 patient local time, except urgent | Due times set by tier |
| Ends with | A retake, a reply, or nothing | A call and a logged disposition |
A text that says "your reading was higher than expected" gets a retake. A text that says "your blood pressure was 168/104" gets a frightened patient, a search engine, and sometimes a medication change nobody ordered. The number belongs with the clinician.
How a reading becomes an action
Every reading is tiered the moment it arrives, against thresholds the clinic sets. There are four outcomes: in range, notice, act and urgent.
Caesar
A reading arrives
Caesar
Tiered on arrival
In range
Caesar
Counts toward the month
Notice or act
Patient text
Retake request
Caesar
Re-tiered on the retake
Caesar
Back in range: closes, logged
Caesar
Notice: review queue, no task
Clinic staff
Act, or no retake: call task
Urgent: no retake first
Patient text
Symptom check, any hour
Clinic staff
Top-priority task and on-call alert
Clinic staff
Staff make the call
Caesar
Disposition logged on the patient's activity
- Caesar
- Patient text
- Clinic staff
- CMS rule
| Tier | Patient | Staff |
|---|---|---|
| In range | No text | No task. The reading counts toward the month. |
| Notice | Retake request | Review queue, no task. Flagged if notice readings land on 2 days in 7. |
| Act | Retake request | Call task, same business day, if the retake confirms it or no retake arrives within 90 minutes |
| Urgent | Symptom check, at any hour | Top-priority task and an alert to the named on-call staff member, with a backup at 30 minutes |
The retake comes before the task. A notice or act reading first asks the patient to sit, rest five minutes and measure again. A retake inside 90 minutes resets the tier. A cuff put on over a sleeve, or a reading taken straight after climbing the stairs, closes itself without costing anyone a phone call.
Urgent skips the retake. The patient is told to call 911 if they have warning symptoms and to retake otherwise. The care team is alerted at the same moment, not after the retake.
Staff make the call. Caesar does not place the clinical call to the patient. A live two-way call is also the interactive communication that 99457 and 99470 require, so the call that resolves the alert is the call the month needs.
Every task ends in a disposition. Reviewed, called, medication changed, appointment booked, sent to the ER, or unable to reach. It is logged on the patient's activity with the time and the person.
Missed readings: two clocks per patient
A patient who stops reading is a clinical gap and a billing gap at once. Caesar runs two clocks for every enrolled patient.
Clock 1 · days since the patient’s last reading
- Day 3:
Patient text
First nudge
“Please take a reading today. Reply HELP if your device isn’t working.”Clinic staff
Device silent 3 days: troubleshooting task
Power, pairing, signal. Due the next business day. - Day 5:
Patient text
Second nudge
Same ask, same HELP route. - Day 7:
Clinic staff
Staff call task
No reading in 7 days. Due the same business day, while 16 days is still in reach.
Clock 2 · day of the 30-day monitoring period
- Every night:
Caesar
Projected-shortfall check
Fires when 16 days now needs a reading on nearly every remaining day, or the patient is heading below 2.Patient text
Shortfall nudge
“Please take a reading every day this week.”Clinic staff
Task to reach the patient
Due within 2 business days. - Day 20:
Clinic staff
Check-in call task
No live call logged yet this period. Due before day 30. - Day 30:
CMS rule
The period closes
16 or more reading days: 99454. 2 to 15: 99445. Fewer than 2: no device-supply code.
- Caesar
- Patient text
- Clinic staff
- CMS rule
Clock 1 counts days since the last reading. Day 3 and day 5 bring a text asking for a reading today, with HELP for device problems. A device that has sent nothing for 3 days opens a troubleshooting task for power, pairing and signal. Day 7 opens a staff call task, due the same business day.
The day-7 call is early on purpose. A patient reached on day 7 can still reach 16 reading days. A patient reached on day 15 cannot.
Clock 2 counts the day of the 30-day monitoring period. It drives the checks below.
Billing-aware checks
The practice bills, not Caesar. What Caesar does is keep the facts the claim depends on in front of staff while there is still time to act on them. The rules come from CMS; the RPM billing guide sets them out with sources.
Reading days, every day. Each patient shows reading days against 16. 99454 needs 16 or more in the period. 99445, new for 2026, covers 2 to 15.
A projected shortfall, every night. The check fires when 16 days now needs a reading on nearly every remaining day, or when the patient is heading below 2 days, the floor under which no device-supply code applies. The patient gets one nudge to read daily this week, and staff get a task to reach them within 2 business days.
A live-call check on day 20. 99457 and 99470 both require interactive communication: a real-time, two-way conversation with the patient. Texts do not count. If no live call is logged by day 20, staff get a check-in call task, due before day 30.
Only device readings count. A patient's reply, or a number typed into a message, is logged and never counted as a reading day or used to set a tier. CMS requires the data to be collected electronically and uploaded automatically.
Guardrails
- Consent first. The first text is the enrollment welcome and consent request. Nothing else goes out until consent is on the chart.
- Quiet hours. Non-urgent texts wait between 20:00 and 08:00, patient local time. Urgent goes at any hour.
- STOP ends every text at once. The chart is flagged, and staff get a task to reach the patient by phone. HELP returns the clinic's number.
- Not an emergency service. Every patient is told texts are not monitored as an emergency line and to call 911.
- One open alert per signal. New readings update the open alert. They do not stack ten tasks for one patient.
- The clinic owns the clinical content. Thresholds are set by the clinic, for the program and per patient. Clinical instructions come only from the clinic's protocols. Caesar's texts ask for a retake, a reply, or a call to 911.
- Everything is logged. Every text, reply, task, call and disposition sits on the patient's activity, so the month's evidence is assembled as it happens.
What Caesar does not do
- It does not place the clinical call.
- It does not set clinical thresholds or give clinical advice.
- It does not submit claims. The practice bills under its own provider numbers.
- Its activity is not billable time. The treatment-management codes pay for clinical staff and practitioner minutes. The software does the work around those minutes.
Frequently asked questions
What is RPM alert management?+
The rules that decide what happens after a remote patient monitoring reading arrives: whether the patient gets a text, whether staff get a task, how fast, and how the outcome is recorded. Good alert management resolves most out-of-range readings with a retake and routes the rest to a named person with a due time.
Should RPM patient texts include the reading value?+
Caesar's texts never do. A text asks for an action, such as a retake. The value stays on the chart for the clinician, who interprets it. A number in a text invites the patient to interpret it alone.
Does Caesar call patients automatically about RPM readings?+
No. Caesar texts the patient and tasks the clinic's staff. Staff make the call. That call is also the live, two-way interactive communication 99457 and 99470 require.
What happens when an RPM patient stops sending readings?+
Texts on day 3 and day 5 ask for a reading today. A device silent for 3 days opens a troubleshooting task. Day 7 opens a staff call task. Separately, a nightly check flags any patient whose 16-day count is slipping out of reach.
Do text messages count as interactive communication for 99457?+
No. CMS defines interactive communication as, at a minimum, a real-time synchronous two-way audio interaction with the patient or caregiver, and requires it for 99457 and 99470. A month of texts does not satisfy it, which is why Caesar checks for a logged live call on day 20.
Does Caesar bill RPM for the practice?+
No. The practice bills under its own provider numbers. Caesar keeps the reading-day count, the live-call check and the activity log current so the facts behind the claim are on the chart when the period closes.
Who sets the RPM alert thresholds?+
The clinic. Thresholds are editable for the whole program and per patient. Caesar applies them; it does not choose them.
See it on your own program
A pilot runs these rules on your thresholds, your staff and your EMR. The billing guide sets out the CMS rules behind every check.