The concept of Remote Patient Monitoring hasn’t quite lost the gleam of novelty yet, but it is not so new. It has been around since 2018, when CMS realizing the potential of remote monitoring in increasing healthcare efficiency, began reimbursing claims for such services. But the Covid-19 pandemic has accelerated the acceptance and widespread adoption of Remote Patient Monitoring and the trend is likely to continue as the world is slowly opening its eyes to the possibilities of new threats of infectious diseases that can quickly escalate to pandemic proportions. So acting in tandem with the changing needs of the times, CMS has recently overhauled the RPM billing system; introducing new codes, streamlining regulations, and making provisions for easier reimbursements.

It’s the right time for providers to get acclimatized to these changes and assimilate Remote Patient Monitoring into their regular service offerings. So in this article, we aim to provide the clarity and guidance that small practices need to start billing for RPM.

What is RPM?

To start with, let’s explore the most basic question of what RPM is. Remote Patient Monitoring is a digital platform or technology that records the health data of patients in remote locations and transmits this information to providers who can then assess their health and provide care instructions and prescriptions virtually.

Remote patient monitoring allows providers to monitor disease and symptom progression and engage with patients while they are managing their illness from the safety of their homes. This technology is particularly relevant in providing treatment during a pandemic as it reduces the risk of transmission and allows hospitals to use critical resources to treat the most serious cases.RPM can use both wired and wireless measurement devices like blood pressure monitors, weight scales, pulse oximeters, cardiac implants, and blood glucose meters. Providers can use RPM to collect a range of patient health data, including blood pressure, vital signs, weight, heart rate, blood sugar levels, and physical activity. If the condition of the patient turns critical at any point in time, providers can arrange to transport them safely to their healthcare facility.

Who Can Deliver and Who Can Receive RPM?

Physicians and Qualified Healthcare Professionals (QHCPs) can provide and bill for RPM. Clinical staff can assist in managing RPM under the supervision of the billing provider.

Any patient can receive Remote Patient Monitoring. But a provider can order RPM only if captured data is directly relevant to managing a patient’s condition, and he/she must document such justification duly in the patient’s medical record.

Why Should You Start Providing RPM?

RPM has proven to improve the quality and efficiency of healthcare, patient outcomes, and passes on a rippling cost benefit to the whole of the healthcare system. It allows old and disabled individuals to put off moving into nursing facilities

It significantly lowers

  • The frequency of hospitalizations
  • The number of readmissions
  • Prolonged stay at hospitals
  • Costs for the patient, provider, and overall healthcare system

How can you deliver RPM?

Billing for RPM can be tricky with these evolving regulations. So here are some steps that you can follow to deliver RPM services without much assistance.

Step 1: In case you choose to treat non-medicare patients, interact with private payers to determine exact coverage. RPM is payable by Medicare, 22 state Medicaid programs (as of April 2020), and an increasing number of private payers

Step 2: Decide who you will take as RPM patients ( your patient base)

Step 3: Identify the conditions you will manage

Step 4: Select the devices you will use to provide RPM

Step 5: Set up an intake procedure to address matters such as initiating the patient care process, training patients on using the RPM device, installing the equipment in patients’ homes, maintaining the devices, and responding to equipment problems

Step 6: Establish policies and procedures

Step 7: Train staff

Step 8: Market program

You can also entrust all or any of these steps to a reliable RPM program vendor who can take up the effort and management required from the provider and staff. Like any healthcare program, providers should follow HIPAA security and privacy regulations. Providers should also ensure that their RPM devices and technology are compliant with FDA standards. Technology that meets FDA standards can help ensure quality control and assurance, data accuracy, and compliance.

RPM Billing

As we discussed before, the codes for RPM billing have been recently updated. Some of these changes are applicable only during the pandemic and some are more permanent. RPM can now be used for Medicare patients with acute and/or chronic conditions while earlier it covered only for patients with chronic conditions. For the duration of the public health emergency, CMS has clarified that RPM could be provided to new and established Medicare patients.

Codes changes in RPM billing

Initially, CPT code 99091 was used to bill for remote patient monitoring. But in the aftermath of Covid-19 and the increased need for RPM, new codes have been introduced.

Codes Services
99453 Remote monitoring of physiological parameters like weight, blood pressure, pulse oximetry, respiratory flow rate etc, initial set-up and patient education on use of equipment
99454 Devices supply with daily recording(s) or programmed alert(s) transmission, each 30 days)
99457 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes
99458 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

Documents Needed To Bill RPM

At the outset, Providers should mandatorily obtain informed beneficiary consent to receive RPM services.

To document CPT 99453, a physician must include the following documentation

  • practitioner order for device deployment
  • condition(s) for which the patient is being monitored
  • device identification
  • date of delivery of the device to the patient
  • dates on which training is provided to the patient.

For time-based codes (CPT 99457 and 99458), the time spent must be documented clearly.

Remote Patient Monitoring and Telemedicine have been a big part of our response to the challenge of the pandemic and have helped us reimagine healthcare delivery for the post pandemic world. So every forward-looking provider in the challenge-intensive healthcare industry must integrate RPM into their care regimen and allow their patients the choice of receiving care from the comfort and safety of their homes.

Would you like more information or assistance with billing for Remote Patient Monitoring?
Click to schedule a free 30-minute consultation with one of Rannsolve’s RPM Billing consultants to know how you can get the ball rolling on RPM billing with our cost-efficient solutions.

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