Remote Patient Monitoring is becoming a more common practice among Medicare patients who want to keep costs down while still receiving the necessary care they need. RPM billing can be beneficial for patients who are unable to come into the office or clinic due to transportation issues. It is important for providers to review the patient’s records and call if there are any changes such as an escalation in symptoms.

RPM software service that allows providers to keep track of all the patients with their assigned identification numbers. When you have a large number of patients, it is difficult to keep track of those who are compliant with the treatment plan and those who are not. This dashboard data helps make sure that those who are not compliant get noticed, so they can be brought back into compliance.

This has created a new billing code, which is a set of codes used to identify various medical services and procedures offered to medicare beneficiaries.

CPT Billing Code

Remote Patient Monitoring Enrollment 

The first step in healthcare is enrolling the patient. Ensuring that the patient has a routine physical exam, laboratory tests, and other preventative care can help decrease the likelihood of chronic illnesses and illness-related death.

RPM Consent

Consent is a process that allows both the patient and the provider to make a decision about whether or not they want healthcare services. In order to provide safe and effective care, providers should ask patients for consent before providing them with healthcare services which includes asking permission to take their blood pressure, take their temperature

Providers should also inform patients of what the risks are when providing these types of services. Written consent is important to ensure that the patient is not accidentally enrolled. We recommend that written consent be filled out when it is practical and possible. This will allow patients to keep a record of their enrollment if needed.

Consent is a legal document that includes the patient’s understanding of what will happen during treatment. It is important for the patient to understand exactly what they are giving consent for so that there is no confusion about what type of treatment they are agreeing to.

Track Your Device Using RPM Software 

The device to be given to the patient has to be linked to the RPM software and the patient must be educated on it. The patient must understand how it works, what it does, and why is important for them.

The conditions to track must be marked and the condition and device that are being tracked. For example, an RPM tracking device that is linked to an oxygen tank can track when it is empty, or whenever the oxygen level drops below a certain point. This allows for continuous usage of the device.

Medicare insurance is not only meant for the elderly and disabled, but also for people under 65 who are unable to work or have a chronic condition. Medicare insurance is often associated with high deductibles, high copays, and limited benefits. However, medical billing services can help you get the most out of your Medicare coverage by lowering deductibles and making copays more affordable.

Medicare RPM Billing Code for Data Transmission

RPM Data transmission is the process of data being transmitted from a patient to their clinician. This allows improved and more timely diagnosis, treatment, and follow-up care during medical appointments. The code comes into use in many cases where patient care requires 24/7 monitoring and care.

Data Transmission is an additional code that was added to the Part B billing code list. The beneficiary must indicate the type of remote monitoring they have done and the codes to identify the particular features. 

The CMS defines the period of data transmission to be 16 days in a month. The period begins on the first day of the month and ends on the last day of that month. Data is transmitted daily and multiple times, but the standard amount of time that it is permitted to be in use is 16 days.

It is important to get at least one measurement a day from your patient. This will provide you with the necessary data to determine their progress. It also helps prevent any setbacks which could be detrimental to their health.

To minimize transmission errors, the aTouchAway platform from mTelehealth service uses a combination of methods to ensure that the data is received in the order it was sent and not altered in transit. These include cellular encryption, digital certificates, and cryptographic hashes.

Medicare Billing Code for RPM Review and Management 

A new billing code that will allow health care providers to charge Medicare patients who are remote users or have an outpatient service authorization. This billing code addresses the lack of telehealth funding and the need for providers to be able to bill directly through Medicare.

Automated Critical Alerts – Alerts to the appropriate clinical staff if the patient measurement goes outside range. This way all patient escalations are managed and there is no medico-legal issue. 

Smart-Review of Data – Significant amount of data comes in. Instead of manually reviewing the data, an automated smart review that showcases how the data is organized in charts and descriptions will help.

Point and click review – additional information can be added through point and click. It is important that this information is created by a competent medical professional. Many software is created by technical engineers and doesn’t consider medical items. 

With these features, a practice can focus their time on talking with the patient and building relationships with the patient instead of typing in data.

The post Remote Patient Monitoring (RPM) Billing – CPT Codes 99453, 99454, 99457, and 99458 – Help Your Healthcare Organization Increase Revenue appeared first on mTelehealth.

Remote patient monitoring (RPM) is the new standard of care for high-risk/chronic patients. With medical devices that automatically send patient readings to the practice, providers can continue to monitor patient health and intervene when necessary, ultimately improving health outcomes and patient satisfaction. 

Healthcare providers who implement remote patient monitoring are reimbursed for services with CPT codes 99453, 99454, 99457, 99458 and/or 99091. CMS has updated the RPM CPT codes this year. In order to bill for your RPM services correctly and optimize your reimbursement, it’s important to know these updates.  

For 2022, we’ve compiled a list of the top three changes to RPM CPT codes that you need to know. 

1. Communication requirements have been specified  

CPT code 99457 is a monthly reimbursement for the first 20 minutes that a qualified health professional or clinical staff member checks readings, speaks with a patient, coordinates treatment plans and/or develops educational materials. For 2022, CMS has clarified that the provider and patient must have at least two-way, real-time interactive communication in order to bill for this code. 

If your clinical staff does not have the time or resources to fulfill this interactive communication requirement, you can work with a partner that will perform these RPM services for you—and can still bill for this code and CPT code 99458, according to CMS. That being said, your billing practitioner must be available to aid the outsourced staff as needed. 

Learn more about the benefits of outsourcing your RPM services through PatientPoint^® here.  

2. RTM CPT codes have been added 

CMS has added remote therapeutic monitoring (RTM) codes for the first time: 98975, 98976, 98977, 98980 and 98981. You can bill for these codes if your practice is remotely monitoring patients without any physiologic data being involved.  

If you’re tracking a patient’s physiologic data, bill for an RPM code. If you’re tracking non-physiologic data, whether it’s to check on respiratory conditions or ensure a patient is taking their medicine, bill for an RTM code.  

Another major difference between RPM and RTM codes is how the data is reported. To be able to reimburse for RPM services, a device must automatically send the patient data to the billing practitioner. However, for RTM services, patients can report data themselves and provide it to the billing practitioner.  

3. CCM rates have increased 

CMS has boosted the national payment rates for chronic care management (CCM) this year. CPT code 99490 has increased by $22.86, while CPT codes 99439 and 99491 have grown by $10.76 and $3.65, respectively. Many of the Complex CCM and PCM codes also have higher rates in 2022, compared to 2021. 

Another major update to CCM is that CMS has added a new code: CPT code 99437. This code accounts for the subsequent 30 minutes that a physician or nonphysician practitioner spends with a patient.  

Since the CCM rates have gone up, it makes sense to bill for both RPM and CCM codes. Doing so will allow you to optimize your reimbursement and make it worthwhile to offer RPM services to your patients. Plus, you’ll be able to better accommodate your at-risk patients. 

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Remote patient monitoring (RPM) is an important branch, strong augmentation and considerable expansion of telemedicine that has altered the health business.

RPM has played a significant part in reducing the risk of Covid-19, and as a result, it has emerged as a viable alternative to in-person medical examinations. Medical practitioners may now manage patients with chronic diseases from their own homes thanks to remote patient monitoring, which has become a common term.

Specific RPM CPT codes, on the other hand, are frequently used to motivate doctors and promote remote patient monitoring. CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 9909 are some of the rpm billing codes. But what exactly are these codes, and how do they feature? We’ll discuss it in this post.

What are Current Procedural Terminology (CPT) codes?

CPT codes are five-digit numerical codes without a decimal point, while some also include one letter and four numbers. These are numbers allocated to each task and service that a healthcare provider does. They’re employed to bill and track medical services and assigned to various tasks.

Surgical, medicinal, and diagnostic procedures are among the current Procedural Terminology codes which insurers use to decide how much they must pay a provider.

To promote uniformity, CPT codes are the same for everyone everywhere. Some are widely used, while others are rarely used. The codes 99214 and 99213, for example, are general checkups that are frequently used.

These codes, however, do not provide a universal definition of healthcare for everyone. They also don’t guarantee that different healthcare providers get compensated for their services in the same predetermined amount: such complexities are usually spelled out in the contracts between insurers and healthcare providers.

The Healthcare Common Procedure Coding System (HCPCS) codes are quite close to CPT codes; however, they are not identical. In their papers, people that use Medicare use HCPCS codes rather than CPT codes. The American Medical Association is responsible for maintaining, developing, and copyrighting CPT codes (AMA). New codes are allocated to new services regularly, existing codes are changed, and old codes are discarded.

What role do CPT codes play in reimbursement for remote patient monitoring?

CMS developed five primary CPT codes to encourage more healthcare providers to use remote patient monitoring and enhance their revenue streams. The following are the five key CPT codes for Remote Patient Monitoring reimbursement:

• CPT 99453,
• CPT 99454,
• CPT 99457,
• CPT 99458, and
• CPT 99091

The Service Codes for RPM are CPT codes 99453 and 99454, respectively.

CPT Code 99453

CPT Code 99453 was created to help patients who aren’t tech-savvy, can’t navigate their phones, or have trouble utilizing medical devices. This service code helps individuals receive training on using these devices and compensates medical health providers for providing these services to patients.

Because the Centers for Medicare and Medicaid Services (CMS) does not reimburse for the pieces of equipment, this includes the time spent on patient education or onboarding. This code covers the RPM enrolment service code, which is reimbursable.

CPT Code 99453 can only be billed once when it is first set up. The same healthcare provider or National Provider Identifier (NPI) number cannot be used twice.

CPT Code 99454

After a patient has been enrolled in RPM and monthly services have begun, CPT Code 99454 is used. CPT Code 99454, which is used to alert transmissions and report the administration of healthcare devices for health-related data, is reimbursable for these services. The programming and delivery of health-related devices are covered by CPT Code 99454.

CPT Code 99457

CPT Code 99457 reimburses for up to 20 minutes per calendar month spent remotely monitoring physiologic measures such as weight, blood pressure, respiratory flow rate, pulse oximeter, etc. It also includes management services and time spent in interactive communication sessions with patients or caregivers by physicians, clinical staff, and other certified healthcare professionals during the month. The billing cycle for this code is once per calendar month.

CPT Code 99458

CPT Code 99458 is a monthly add-on code for CPT Code 99457 that reimburses health care professionals for each additional twenty minutes of interactive monitoring sessions. Each calendar month, this code can be billed up to two times.

CPT Code 99091

Although CMS still considers CPT Code 99091 valid, the codes listed above better depict the numerous medical circumstances requiring billing. It is limited to data acquired over the course of 30 days and cannot be billed in the same month as CPT Codes 99457 and 99458.

The CCM Health offers a cutting-edge telemedicine platform that helps you improve patient compliance and retention, expand your practice, and generate more revenue. You can create your own virtual care program through RPM in just a few simple steps by joining The CCM Health family! For additional information, visit The CCM Health.

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By  Shailendra Sinhasane   Posted  March 31, 2022

Each year, new Current Procedural Terminology (CPT) codes are renewed by the American Medical Association (AMA). The 2022 CPT code changes are minimal and it brings forth modifications to the existing descriptors and codes in the healthcare system. CPT billing codes create an influx of revenue streams through remote patient monitoring and remote therapeutic monitoring avenues. 

As the remote patient monitoring CPT codes landscape keeps expanding, CMS has revised some of the key RPM CPT codes for 2022 at an affordable rate. The Centers for Medicare and Medicaid Services proposed and published its Medicare Physician Fee Schedule for 2022. In the new CPT codes for 2022, CMS recognized close to 5 new CPT codes for remote therapeutic monitoring, focussed on COVID-19 specific CPT codes 2022, and for CPT codes in chronic care management. 

Before speaking about the 2022 coding changes in CPT, let’s understand what their code changes signify.

Significance of 2022 CPT Code Changes

The healthcare industry in the US is regularly evolving with the inclusion of driving factors like advanced digital health technology, regulatory guidelines, interoperability of data, a shift in value-based care payment models, the changing patient demographics, and consumer experiences. The innovation in care delivery services has included the telehealth CPT codes 2022 and the COVID-19 codes have also been remodified to ensure the healthcare revenue cycle.

As healthcare businesses provide multi-faceted services through medical coding and billing services, physicians need to navigate successfully the new trends in the healthcare scenario. 

Here are a few trends in medical billing and coding services in 2022. 

1 Inpatient Prospective Payment System FY 2022

The Inpatient Prospective Payment System (IPPS) final rule for the fiscal year (FY) 2022 increased the hospital reimbursement value by 2.5% and also increased the rates for COVID-19 therapies and diagnostics. 2022 final rule now has included the codes for procedures and diagnostics and Medicare groups with severe diagnosis-related adjustments. The IPPS for FY 2022 focuses to improve the quality of measurement and data evaluations in the healthcare department.  CMS is aiming to leverage the lessons learned during the pandemic to improve the care quality and enhance patient-provider transparency for taking better and more informed decisions regarding their care. 

2 Medical PFS 2021

The Medicare Physician Fee Schedule (PFS) included the changes in reporting E/M services, enhancing payment for special services, reducing payment structure for other healthcare concerns, and expanding the telehealth provision list. All of these inclusions are playing a significant role with the help of medical insurance codes and CPT billing codes.

3 2022 New medical coding

Since 2022, medical coding companies and healthcare providers have been dealing with challenges that hamper the assurance of receiving accurate clinical coding and documentation for the COVID virus that had no documents recorded before. The major changes in medical coding to account for COVID-related conditions have new CPT codes that detect the treatment and immunization and it is well expected in 2022. To the additional changes in the Medicare PFS, the ICD-10 codes for FY 2022 include at least 159 new coding changes, 22 codes have been revised, and 30 codes have been invalidated. The coding teams are gearing up to help providers utilize the new coding systems. 

4 Billing and documentation of virtual visits

The pandemic shifted patient care from outpatient to virtual visits and consultations. Telehealth usage has increased by almost 38 times since the coronavirus epidemic. The telemedicine rules are continuously changed and regulated due to this, and commercial and Medicare payers are required to have specific payment needs, especially when it observes virtual visits. Other than the rapid adoption of telehealth services see an increased rise in 2022 with the rise in chronic conditions and with the growing senior population with a shortage in physicians and providers. Unique and specific for telehealth CPT codes 2022 includes EM visits, new requirements for billing, and the usage of including code modifiers. This modifier 93 enables better reporting of medical services offered through real-time communication and interactions with providers and other healthcare professionals through technology-based only on audio communication. 

5 2022 CPT code changes in claim denials

Billing services that are correlated to the pandemic is still a major challenge in healthcare. Almost 40% of rates were initially in claim denials for COVID-related cases in the first 9-10 months. In 2022, healthcare providers and medical coders are requested to work on documentation improvements to mitigate claim denial challenges which are one of the larger parts of compliance risks for healthcare organization businesses and generation of revenues. 

The 2022 CPT code changes and medical billing trends are evolving constantly. The teams involved in medical coding and billing organizations are understanding the importance of coding education to keep up with the healthcare technology trends. They are adhering to the top and best practices required in medical coding and billing ensuring accurate claims submissions and timely meets with the payer guidelines, and hospitals and healthcare providers are looking to maximize their reimbursements to improve the patient care experience. 

2022 CPT Code Changes in Remote Patient Monitoring for Reimbursement Rates

The final rule in 2022, CMS has offered its support to remote patient monitoring and telehealth with five new codes under remote therapeutic monitoring (RTM). With the expansion in remote patient monitoring, CMS revisited and revised some of the key remote patient monitoring CPT codes at affordable rates. The 2022 CPT code changes and reimbursements for the existing remote patient monitoring CPT codes are:

Remote Therapeutic Monitoring and the New CPT Codes 2022

The Centers for Medicare and Medicaid Services released the PFS for 2022 on remote therapeutic monitoring (RTM) codes. 5 new codes have been included in the RTM. Before discussing the 2022 coding changes and new implementations, let’s understand what Remote Therapeutic Monitoring and its codes mean. 

The Purpose of Remote Therapeutic Monitoring

Remote therapeutic monitoring in general has management codes that are specifically designed to mirror the remote patient monitoring CPT codes. Remote therapeutic monitoring’s (RTM) intended plan of action is the management of patients with the help of medically designated devices by collecting non-physiological evidence and data. Despite the coverage planned by CMS fr covering RTM as one of the proposed rules, the importance of the RTM concept is to note the specific requirements that are still undefined. 

The CMS has discussed two differences between RPM and RTM that are major. In RPM, providers cannot bill patients for RPM services but maybe provide a CPT bill for RTM. the proposed rule for RTM shows how Medicare has pointed out that the AMA designated RTM codes as non-evaluation and management (E/M) codes, which disallows Medicare to lace them as general supervision care delivery management codes. The second way RPM is different from RTM is the nature of the data collected. RTM can be worked for non-physiological healthcare devices, for example, support for medical adherence. Any information on a medical device that can be collected which are non-physiological and be billed under remote therapeutic monitoring. 

New CPT Codes for 2022: Remote Therapeutic Monitoring

The 2022 CPT code changes and the inclusion of new codes in RTM have expanded the use of Medicare plan coverage for remote monitoring patients that are beyond the scope of RPM. this is one of the breakthroughs for 2022 in the digital health reimbursement schemes.  Healthcare stakeholders have suggested that the recent RTM 2022 CPT codes were created to enable providers and practitioners who are unable to bill for RPM CPT codes. The remote therapeutic monitoring codes for 2022 include: 

• 98975: Equivalent to the RPM CPT code 99453, the initial setup and education of patients are used for equipment. This code allows providers to bill at least one episode of care. The care delivery starts with RTM services being activated and comes to a conclusion when the goals of specific treatment are met. 
• 98976: RTM devices, especially needed for respiratory systems, require the CPT code to be supplied with scheduled daily programmed alerts and recordings transmissions are needed for monitoring respiratory systems every 30 days by proper providers. 
• 98977: Remote therapeutic monitoring devices for this CPT code are required to be transmitted with the supply of scheduled recordings and programmable alerts for transmissions for monitoring the musculoskeletal systems every 30 days. The codes 98977 and 98976 are billable once per 30 days of monitoring. 

98980 and 98981: RTM treatments, physicians/providers who are exceptionally qualified in healthcare delivery on time in a month are required to have at least one interactive communication with the caregivers of the patients and the patients during that month for at least 20 minutes of the said month via phone calls or video communications.

Other Key Takeaways with the new CPT Updates in 2022

The changes to the 222 CPT code changes are editorial and set on the base of coding demands required for precision medicines, digital health, augmented intelligence, and other necessities of the new healthcare frameworks. Some of the other CPT code updates include:

• 4 new codes 99424, 99426, 99427,  and 99425,  have been implemented as the principal care management offerings for allowing healthcare providers to accurately report care delivery to patients with complex chronic conditions. 
• A new appendix solely created for taxonomy required for digital medicine services that supports the awareness and understanding of patient care approaches via multifaceted availability of digital medicine for reporting the code set for CPT. 
• The new CPT billing changes are ensuring better and more accurate coding and reporting of COVID-19 vaccinations and administration services. The AMA is offering vaccine code finder sources to assist in identifying the appropriate CPT code combinations regarding the type and the dosage of the coronavirus vaccine for every patient. 

Bottomline, 

The 2022 CPT code changes are creating a new stream of revenue by providing better RTM and RPM services to make it more profitable and easier to implement for the healthcare billing and coding teams. The new changes in CPT codes can pique the patient care delivery by providers and caregivers for delivering a better care experience to patients with regular monitoring and appointment scheduling. Companies involved in digital healthcare services can help to deliver customizable and comprehensive software that fits the needs of healthcare organizations. 

The post Preparing for the 2022 CPT Code Changes Evolving Remote Patient Care appeared first on mTelehealth.

By: Collin Couey on March 25, 2022

Imagine spending precious time and money setting up a remote patient monitoring program at your practice only to realize it’s too costly to maintain. If you’re on the fence about setting up such a program, you can avoid that worst-case scenario. We’ll break down the ins and outs of remote patient monitoring reimbursement so you can feel confident that it makes financial sense for you.

 What is remote patient monitoring?

Remote patient monitoring is a healthcare delivery model that uses tech to monitor patients’ health outside of your clinic or practice. Put simply, remote patient monitoring uses electronically transmitted patient health data to assess and monitor patient vitals remotely.

Practices that can master the reimbursement component shouldn’t hesitate to reap the many benefits of a remote patient monitoring program. For you, it’s a chance to get a more complete look at your patient’s overall condition while boosting your marketing and patient retention efforts. For patients, remote monitoring helps them establish a chronic care management routine and gives them more control over their health.

Understand how remote patient monitoring coverage works

Remote patient monitoring reimbursement is pretty simple from a coverage perspective because it’s covered by Medicare as well 27 state Medicaid services. Additionally, many commercial insurance providers cover remote monitoring using their telehealth coverage policies. In fact, the number of commercial insurance providers who offer remote patient monitoring coverage has increased due to the COVID-19 pandemic.

When planning a remote patient monitoring program, it’s important to take stock of your practice’s patient population to determine whether your practice is a good candidate to make a continual profit. For instance, if you have a lot of Medicaid and Medicare patients with chronic conditions (heart disease, high blood pressure, diabetes, etc.), you probably have enough patients to set up a remote patient monitoring program right away.

On the other hand, if you’re a smaller independent physician who mostly sees privately insured patients who don’t experience chronic conditions, you might not be well set-up to start a remote patient monitoring program today.

Additionally, remote patient monitoring should be one of your first thoughts for patients with chronic conditions who prefer telehealth, telemedicine, or at-home treatment who are insured or qualify for Medicare or (in some cases) Medicaid services because they are covered and your reimbursement process will be simple.

 Key considerations: If you want to start a remote patient monitoring program, it’s important to have a firm grasp on your patient population. Running patient surveys to gauge interest is a great place to start once you know if your patient population can support a robust and profitable remote patient monitoring program.

Know which CPT codes are crucial for remote patient monitoring reimbursement

If you want to be reimbursed, you need to know which Current Procedural Terminology (CPT) codes are important for remote patient monitoring services.

The five primary Medicare RPM codes are CPT codes: 99453, 99454, 99457, 99458, and 99091. Remote patient monitoring codes are considered evaluation and management (E/M) services and can be ordered and billed only by a healthcare provider or non-physician provider who are eligible to bill Medicare E/M services.

Most remote patient monitoring services will be billed under four codes that are split into two categories: service codes and timed remote patient monitoring management codes.

Remote patient monitoring service codes

CPT code 99453 and 99454 are practice expense only codes specifically related to device set-up and education and are valued to cover clinical staff time, supplies, and equipment, including the medical device for remote monitoring.

Remote patient monitoring management codes

• CPT code 99457 reimburses medical professionals and healthcare organizations for their time spent performing duties related to interpreting remote monitoring physiologic data such as medical decision-making to assess patient stability, communication with patients either in person or via telehealth service, and oversight of the management and coordination of service.
• CPT code 99458 is an add-on code to 99457 for each additional 20 minutes of remote physiologic monitoring treatment management service provided in a 30-day calendar month.
• CPT code 99091 is for the collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional. It can also be billed monthly but has more requirements than CPT codes 99457 and 99458.

 Key considerations: Practices risk financial losses if they fail to code care correctly with the Center for Medicaid and Medicare Services (CMS), so if your care organization is thinking about adopting a RPM service, you need to know what CPT codes to worry about and how they affect your practice.

For a much more detailed breakdown of how CMS and remote patient monitoring work together, check out A Guide to Remote Patient Monitoring and CMS.

Calculate how much Medicare pays per CPT code assigned to remote patient monitoring

It’s important to understand how much you can expect to get paid per patient for your remote monitoring services.

Here’s how remote patient monitoring reimbursement breaks down using average Medicare reimbursement:

• Using CPT code 99453, Medicare pays a one-time payment of $18.48 for initial patient enrollment into the program. This includes the setup of the remote patient monitoring device, the delivery of the device, patient education, and receiving initial remote patient monitoring services.
• Using CPT code 99454, Medicare provides a base monthly payment of $55.77 for continuously monitoring patient data transmitted from the device (like blood pressure or blood sugar levels) as well as ongoing management of the device.
• Using CPT code 99457, Medicare provides a monthly payment of $50.18 for 20 minutes of communication between the patient and caregiver or practitioner specifically pertaining to the data transmitted by the device.
• Using CPT code 99458, Medicare provides an additional $40.84 if the time spent exceeds 20 minutes but is less than 40 minutes. If you spend more than 40 minutes per month, Medicare will provide an additional $40.84 dollars. There is no additional reimbursement after 40 minutes.
• Using CPT code 99091, Medicare provides a monthly payment of $56.41 for collecting and interpreting the transmitted and stored physiologic data provided by the remote patient monitoring device. The amount of time spent interpreting and analyzing must be at least 30 minutes to qualify for reimbursement.

A single remote patient monitoring patient will earn your healthcare organization $2,928.48 per year, assuming you get reimbursed the maximum reimbursement per month.

If your practice enrolls 50 patients into a remote monitoring program, and, assuming you get reimbursed for the maximum amount you can each month for each payment, you’d earn $147,348 in annual Medicare remote patient monitoring reimbursement. Even after you factor in the cost of remote patient monitoring software, you’d still be yielding a significant and consistent amount of revenue.

 Key considerations: Realistically, your care organization will likely only meet the initial 20 minutes for reimbursement, and you also might not consistently meet CPT code 99091 each month, so it’s important to factor in how much time you can feasibly devote to each patient enrolled in the program when calculating potential revenue.

Understand which CMS guidelines pertain to remote patient monitoring reimbursement

You must understand the CMS guidelines for remote patient monitoring to reduce the likelihood that your claims get denied.

In order to even qualify for reimbursement, CMS expects your practice to follow these remote patient monitoring requirements:

• Charge Medicare Part B patients a 20% copayment.
• Receive verbal or written consent from a patient to receive remote patient monitoring services.
• Ensure the remote patient monitoring services are ordered by a physician or other “qualified healthcare professional” (nurse practitioner, certified nurse specialist, or physician assistant).
• Monitor patients for at least 16 days per billing period.
• Verify physiologic data can be wirelessly synced for evaluation.
• Confirm each remote patient monitoring device meets the U.S. Food and Drug Administration’s definition of a medical device.
• Ensure the remote patient monitoring device can digitally and automatically upload patient physiologic data which cannot be self-recorded or self-reported by the patient.

Key considerations: Meeting these requirements should be relatively easy for any healthcare organization, but it’s important to have a complete understanding of them in order to avoid claims denials and scrutiny.

Remote patient monitoring allows practices to provide an important service while also being reimbursed

Remote patient monitoring is swiftly becoming more important than ever for patient care because of the shifting necessity and popularity of telehealth, telemedicine, and virtual care. It’s also an aspect of value-based care, which is a pricing model that incentivizes your practice based on the quality of services you provide to patients.

Adopting a remote patient monitoring program will help your healthcare organization get a more complete look at your patient’s overall condition, give your patients more control over their health, and will make your practice more marketable while helping retain patients.

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