Daily, weekly, and monthly RPM workflows
What a triage nurse does at 8am, what a clinical manager checks each Friday, and what a healthy RPM program looks like by the numbers.
A healthy RPM program runs on rhythm. Triage nurses work the alert and escalation queues every morning. Clinical managers audit the program's shape every week. Billing closes out the month on a fixed cadence. This page lays out the cadence so a new nurse can pick it up on day one and an experienced manager can use it as a checklist.
Daily workflow: triage nurse
The triage nurse owns the alert queue and the first-line escalation queue. Most of the day's work happens before lunch.
8:00: log in and read the dashboard
Open Monitoring -> Patient Monitoring. Glance at the KPI strip:
- Critical count. Your morning priority. Aim to clear this to zero by 11:00.
- Pending count, should be < 5. If it's growing through the morning, ingestion is delayed; tell the platform admin.
- Today count. Readings processed since midnight. Sanity-check this against patient census; for a 200-patient program you should see 250–400 readings in the first hour of the day.
8:00–9:00: work the Critical filter
Click the Critical chip. Walk down the list top to bottom:
For each row, click Charts to see whether the value is a spike or a pattern.
Open the patient's chart in a new tab and call them. Use the Escalations call script. Five questions, one repeat reading.
Either acknowledge the alert with a clinical note (if you handled it inside RPM scope) or escalate (if the patient needs a provider).
Move to the next patient. Don't perfect the documentation in the first pass. Get to every critical patient first, then come back to clean up notes.
9:00–11:00: work the Warning queue
Switch to the All filter and scan for orange-pill rows. These are patients with non-critical alerts that still benefit from a touch. A typical mix:
- Quick reinforcement calls ("Don't forget your morning lisinopril").
- Reading-technique coaching for new patients.
- Trending-up readings that need a same-week provider note.
A 30-minute block here clears most warning alerts for a 200-patient panel.
11:00–12:00: escalation follow-through
Open Monitoring -> Escalations and click the Active filter. Walk down:
- STAT in Pending for > 5 minutes, call the provider directly.
- Urgent in Acknowledged. Confirm the provider has a plan and add a follow-up reminder if needed.
- Routine in any state. Leave to the provider's next session.
13:00–17:00: patient outreach and documentation
Afternoon is for the slower work: scheduled callbacks, medication reconciliation, documentation cleanup, and capturing time on calls that weren't tied to an alert (CPT 99457/99458 minutes. See Documenting for billing).
End of day: sanity check
Before you close the laptop:
- Critical count should be 0 or every remaining critical should have a documented note and an active escalation.
- Active escalations count should match what the provider is carrying into tomorrow.
- All time you spent on patient care should be logged. If you wait until Friday, you will lose minutes.
Weekly workflow: clinical manager
Every Friday afternoon, 30–60 minutes:
Open the practice's escalations dashboard. Look at Avg Response for the week. Targets: STAT < 2 minutes, Urgent < 4 hours, Routine < 24 hours. Anything trending up is a staffing or workflow signal.
Audit a sample of 5 closed escalations. Pick at random: one STAT, two Urgent, two Routine. For each, read the Reason details, the Action taken note, and the billing entries. Are they consistent? Did the documented action match the severity?
Review the missed-readings list. Pull Patients -> filter: no readings in last 72 hours. Anything > 5% of your panel means your team needs to step up patient outreach.
Check the device fleet. Devices -> Inactive preset. Anything > 14 days inactive should be in a return or replacement pipeline already. If it's not, your team has dropped a thread.
Glance at billing readiness. Billing -> Periods -> Current month. Track the percentage of patients on track to qualify for 99454 (16+ monitoring days) and 99457 (20+ minutes interactive care). Both should climb steadily through the month.
Monthly workflow: closeout
The first three business days of each month are the closeout window for the prior month. Run this sequence on the 1st:
Reconcile the alert log. Open Monitoring -> Alerts -> Resolved filtered to the previous month. Spot-check 10 auto-resolved alerts to confirm none should have been escalated.
Close out billing periods. Billing -> Periods -> previous month. For each patient, confirm the CPT codes that were captured (99453, 99454, 99457, 99458 add-ons) and finalize.
Run the program-health report. Most clinics use a simple five-number scorecard:
- Patients enrolled (target: growing month-over-month)
- 99454 capture rate (target: > 70% of enrolled)
- 99457 capture rate (target: > 60% of enrolled)
- Average response time on STAT escalations (target: < 2 min)
- Devices unassigned for > 30 days (target: < 5% of fleet)
Run inventory. Devices -> filter: Lifecycle = Returned. Decide what's reissuable, what's getting repaired, and what's retiring. Update each row's lifecycle accordingly.
What "good" looks like
A well-run RPM program has these characteristics. Use them to benchmark your own.
Alerts and escalations
- Critical alert acknowledgement time averages under 15 minutes during business hours.
- STAT escalation acknowledgement time averages under 2 minutes.
- No more than 5% of alerts are still unacknowledged after 4 hours.
- The Critical queue is empty by 11:00 every weekday.
Engagement
- At least 80% of enrolled patients transmit a reading in any given 7-day window.
- At least 70% of enrolled patients qualify for CPT 99454 each month (16+ days of readings).
- Fewer than 10% of patients are flagged as non-compliant in any given month.
Billing capture
- CPT 99453 is captured for every newly enrolled patient in their first calendar month.
- CPT 99454 capture rate exceeds 70% of enrolled patients per month.
- CPT 99457 is captured for at least 60% of enrolled patients each month. Every patient should hit 20 minutes of interactive care management with a clinician inside any given month.
- CPT 99458 add-ons average 0.5–1.0 per qualifying patient (i.e., the practice is capturing the second 20 minutes when it happens, but not stretching every patient to 40+ minutes for the sake of billing).
Devices
- Less than 5% of the fleet is in Returned or Lost state for more than 30 days.
- Fewer than 2% of devices are out of warranty without a replacement plan.
- Battery filter: Low has fewer than 10 patients on it at any time.
These numbers are starting points. A practice serving a young, tech-comfortable hypertensive population will run hotter on engagement and lower on critical alerts. A practice serving high-acuity post-discharge CHF patients will run lower on engagement and higher on escalations. Adjust your targets to your panel.
Common failure patterns and how to fix them
- Critical queue grows through the day. Triage nurse is understaffed for the panel size. Either add coverage or tighten patient thresholds so fewer non-actionable alerts fire.
- 99457 capture rate stuck below 50%. Time is being spent but not logged. Coach the team on documentation discipline.
- Devices accumulating in Returned state. Inventory team has fallen behind. Block 90 minutes a week to process returns, sanitize, and reissue.
- STAT response times creeping up. On-call provider isn't monitoring the in-app notifications. Switch to a paging service that confirms delivery.
- Engagement dropping in week 3 of every month. New patients aren't getting their week-2 check-in call. Add a recurring task in your team's workflow tool.
A weekly Monday huddle with the triage nurses and the clinical manager (15 minutes, agenda lifted from this page) catches almost all of these before they become structural problems.