Patient Consent for Remote Therapeutic Monitoring (RTM)

1. What Remote Therapeutic Monitoring Is

Remote Therapeutic Monitoring, or RTM, is a service covered by Medicare and many other insurance plans. It allows your care team to follow your progress between office visits.

You use the VitaTrax app on your smartphone or tablet to report information such as your pain levels, how you are doing with your exercises or therapy, whether you are taking your medications, and how you are responding to treatment. Your care team reviews that information and will contact you if they have questions or concerns, or if your care plan needs to change.

RTM does not replace your office visits. It is an addition to the care you already receive.

Your practice may also offer other care management programs, such as Chronic Care Management or Principal Care Management. Those programs have their own consent forms.

2. RTM Is Not Emergency Monitoring

Your care team reviews the information you submit during normal business hours. There may be a delay of hours or days between when you submit information and when someone reviews it. Never rely on the app to alert anyone to an urgent or life-threatening problem.

If you have an urgent but non-emergency concern, call your practice directly.

3. Only One Provider Can Bill for RTM Each Month

Medicare and other insurers allow only one healthcare provider to bill for RTM in a given calendar month.

By enrolling, you understand that the practice enrolling you will be the billing provider for RTM during the months you are enrolled. You should not enroll in Remote Therapeutic Monitoring or Remote Physiologic Monitoring with another provider for the same period. If another provider offers you a similar program, tell both practices so they can sort out which one will bill.

4. What You May Owe

RTM may result in out-of-pocket costs depending on your insurance plan. You are responsible for all applicable copayment, coinsurance, and deductible amounts. If you are a Medicare beneficiary, this includes the standard 20% coinsurance for Part B services.

Before you enroll, a staff member at your practice will review your specific cost-sharing responsibilities with you and tell you what you can expect to owe. Please ask if anything is unclear.

Your practice bills your insurance. VitaTrax does not bill you. If you have a question about a bill, contact your practice.

5. How Your Health Information Is Shared

To provide RTM, your practice shares relevant parts of your health information with the members of your care team and with VitaTrax, the software platform used to deliver and document the service.

VitaTrax handles your health information as a business associate under a written agreement with your practice, and in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable privacy laws. Your practice’s Notice of Privacy Practices describes your privacy rights and how your health information may be used and disclosed.

By consenting, you give your practice permission to share your health information as reasonably necessary to provide RTM and coordinate your care.

To exercise your rights over your health information, including access, copies, amendment, or an accounting of disclosures, contact your practice.

6. You Can Stop at Any Time

Your participation is completely voluntary. You may stop at any time, for any reason, by telling your practice.

Stopping will not affect the quality of care you receive or your ability to get other care from your practice.

When you withdraw, your practice will document it, discontinue RTM, and stop billing for it.

Deleting the app from your phone does not end your enrollment and does not stop billing. You must tell your practice.

Your practice may also end your participation, for example if RTM is no longer appropriate for your condition, if you are not using the program, or if your coverage ends.

7. What You Are Agreeing To

By consenting to participate, you acknowledge each of the following:

1. Your physician or other healthcare provider has explained what your RTM program involves, the type of health data that will be collected, and how it will be used in your care.
2. Your health data may be collected and transmitted digitally from the app to your healthcare provider. Reasonable safeguards are used to keep that information confidential and secure.
3. You will not transmit, or allow to be transmitted, the health data of anyone other than yourself.
4. You will not intentionally tamper with, alter, or interfere with the app or any device used for your monitoring, and you will not submit information you know to be false.
5. Your physician or healthcare provider is not responsible for inaccuracies in the health data you transmit. The program only works if what you report is accurate and consistent.
6. You consent to the use of RTM as part of your care and treatment.
7. You have the right to withdraw from the program at any time.
8. You are responsible for all applicable copayment, coinsurance, and deductible amounts, including, if you are a Medicare beneficiary, the standard 20% coinsurance for Part B services.
9. RTM IS NOT AN EMERGENCY SERVICE AND YOUR DATA WILL NOT BE MONITORED 24/7. IF YOU THINK YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.

8. How You Give Your Consent

Your consent is given to your practice. Your practice may document that consent on paper or electronically in the VitaTrax app. Either method is a complete record of your consent on its own.

On paper. Your practice reviews these terms with you, answers your questions, and asks you to sign a consent form. Your practice keeps the signed form in your medical record.

In the app. When you set up the VitaTrax app, you are asked to review these terms and indicate whether you agree. If you agree, you are giving your consent to participate in RTM. The app records the date and time, the version of the terms shown to you, and how your identity was verified, and provides that record to your practice for your medical record.

By agreeing in the app, you confirm that your practice has explained the program to you, that you had the opportunity to ask questions, that you have read and understood these terms, and that you agree to your consent being given and recorded electronically rather than on paper.

Your consent is given to your practice. VitaTrax provides the software your practice uses to record it and is not a party to your consent.

If someone is helping you. If you are a parent, caregiver, guardian, or authorized representative acting on a patient’s behalf, you confirm that you have the legal authority to consent for that patient, and your agreement has the same effect as the patient’s.

9. Questions

For questions about your care, your enrollment, what you may owe, your health information, or stopping the program, contact your healthcare provider’s practice. They are the right place for all of these.

For questions about how the VitaTrax app works, see the Patient Terms of Service and the Privacy Policy, or write to info@vitatrax.co.

In an emergency, call 911.