Why Isn't My Patient RTM-Billable Yet? The Gate Checklist

"The data's there, the patient's recovering — why can't I bill RTM yet?" Almost always, the answer is that one gate in the chain hasn't been cleared. RTM readiness isn't a single switch; it's a short sequence, and the trick is to walk it in order and stop at the first thing that's missing.

The seven gates, in order

1. Registered & email-verified
   What it means: the patient has a real account and clicked their verification link. Fix: have them finish registration and verify their email — until they do, they aren't an active, monitored patient.
2. Active consent on file
   What it means: the patient has given (and not withdrawn) consent to share recovery data with you. Fix: no documented consent, no billable RTM — have them complete the consent step.
3. Assigned to you
   What it means: the patient is linked to your panel (in BoneArc, via your referral code). Fix: a guest who never used your code isn't yours to bill — re-issue the code and have them register with it.
4. Enrolled in RTM
   What it means: the monitoring episode is established. Fix: complete enrollment so the episode — and its clock — actually starts.
5. Enough data-days logged
   What it means: the patient has logged recovery data on enough distinct days this period to reach a device-supply threshold (2–15 or 16+ data-days). Fix: encourage daily check-ins; more logged days move them up the ladder.
6. Documented review / management time
   What it means: you've accumulated documented time reviewing and managing the patient's data. Fix: the treatment-management codes need your reviewed time captured — log it as you do it.
7. Interactive call logged & attested (management codes only)
   What it means: a real-time, two-way call with the patient, documented and attested. Fix: daily logs and chart review don't count — log and attest the call for any treatment-management code.

Gates 1–6 get you to device-supply billing readiness. Gate 7 — the interactive call — is the additional requirement for the treatment-management codes (see the full code ladder).

Walk the gates top to bottom and stop at the first one that's red. That's almost always the whole answer.

The timing layer that sits on top

Even when all seven gates are green, three timing rules govern whether you can bill this month:

• The global period. A post-surgical patient's operating surgeon generally can't bill RTM during the 90-day surgical global period — though a PT or PM&R provider often can. (Full breakdown in the global-period guide.)
• RTM/RPM exclusivity. You can't bill RTM and RPM for the same patient in the same calendar month.
• Monthly certification. Once you certify the month's RTM activity, it's finalized and locked.

How to answer "why isn't my patient billable?"

• Walk the seven gates in order and find the first one failing — that's usually the answer.
• Give the plain reason and the concrete next step (verify email, complete consent, use the code, log more days, document the call).
• If the patient clears every gate but you expected a specific code or rate, that's a billing-detail question — confirm figures with your biller.
• If a claim was denied or rejected (not a readiness gap), that's a different problem — route it to your biller, not the checklist.