How to Navigate Remote Patient Monitoring Reimbursement?

Remote patient monitoring (RPM) uses several technologies and devices to help physicians observe patients outside clinical settings. It transmits patients’ vital signs like heart rate, blood pressure, and electrocardiogram (ECG) to providers for evaluation. This enables them to provide medical services without seeing patients in person. Needless to point out, it is important for health plans to include remote patient monitoring reimbursement as it is a valid healthcare service.  

Gadgets like Apple’s Smartwatch, Fitbit, and other wearable devices collect several health vitals. These have grown in popularity globally and have demonstrated their feasibility in supporting remote patient monitoring programs. But the policy framework for RPM reimbursement requires some work, as payers have mixed feelings about this. It is important to consider since telehealth and RPM will have a bigger role in American healthcare. We will discuss the ins and outs of remote monitoring reimbursement in further detail.  

Coverage For Remote Patient Monitoring

To understand the reimbursement for remote patient monitoring, it is first necessary to know about coverage. Many commercial insurance providers have begun offering coverage for remote patient monitoring since the Covid-19 pandemic. That number has been increasing since payers have realized that RPM tends to reduce the cost of care. Furthermore, it is covered by Medicare and Medicaid services in 27 states.   

Providers planning to begin a remote patient monitoring program must consider their patient population first. The factors to think about revolve around continued profits since implementing advanced telehealth solutions is an investment that must offer reliable returns in the long term. Providers seeing many patients with chronic conditions covered by Medicare and Medicaid would be better off with an RPM program.   

Chronic conditions are diseases that last long and generally require extensive treatments. Most of those cannot be cured, only managed. So, providers would need continued use of custom healthcare software solutions for chronic care management. Since Medicare and Medicaid would cover it, such providers are better off using RPM solutions for chronic diseases. Regarding actual implementation, the software can be integrated with practice management solutions for easy electronic data interchange.   

Patients suffering from chronic diseases would need to be regular with their check-ups and follow-ups. They would send over their vitals, which were taken at their house, and need to come for in-person visits as the provider prescribes. In other words, an RPM program at a provider would pay for itself over some time.  

On the other hand, a physician with her practice who sees patients with private insurance and fewer chronic cases might not be well-off with an RPM program. While many private insurance payers don’t cover remote patient care, many do. So, providers seeing such patients are better off not offering remote monitoring services.  

CPT Codes For Remote Patient Monitoring Reimbursement

Providers vying for RPM reimbursement must know the Current Procedural Terminology (CPT) codes to offer that service. Medicare RPM codes are categorized as evaluation and management (E/M) services. As the name suggests, they can be prescribed and billed by a provider or caregiver eligible for billing Medicare evaluation and management services.   

The main Medicare RPM codes are classified as service codes and remote patient monitoring management codes. Let’s have a detailed look at them  

Service Codes For Medicare RPM Reimbursement

Codes 99453 and 99454 for remote patient monitoring reimbursement are codes related to devise set-up and training. They mainly cover staff time, equipment, and supplies, including the actual medical device used for monitoring.  

Codes For Medicare Reimbursement For Remote Patient Monitoring Management 

99457 – This is used to reimburse providers, non-clinical professionals, and healthcare organizations for time spent on remote care activities. These include assessing medical data obtained from RPM programs, assessing the patient’s situation, and staying in contact with patients for medical reasons. Moreover, this CPT code for RPM Medicare also covers services like coordination of remote monitoring services and managing the process.   

99458 – This is an add-on for the previously mentioned 99457 code. It applies for each additional slot of time spent in RPM treatment management across a specified period.   

99091 – This code is for collecting and assessing medical data stored and transmitted digitally to the provider. It can be billed monthly but has more requirements than codes 99457 and 99458. The monthly billing is likely to happen in case of chronic diseases, as those patients would need extensive continuous treatments. Since they require such care, the patients will continuously transmit their data over a long period.

Guidelines For Ensuring Remote Patient Monitoring Reimbursement  

CMS expects certain guidelines from providers when providing coverage for RPM services. Providers must follow them strictly to prevent or minimize the chances of claim denials and rejections.   

Let’s examine those guidelines closely – 

• Verbal or written consent from patients to receive care services that can be classified under RPM. This is one of the most important rules that providers must remember. Some patients, like seniors at assisted living facilities or receiving home-based care, might be unable to consent. In such a situation, following the proper channels before beginning RPM services is important.
• Violating any of those channels would result in potential loss of reimbursement and legal action for the providers or medical organizations.  
• The RPM services need to be ordered by a doctor or a qualified and certified medical professional. This could include nurses and other caregivers who can manage a remote patient monitoring program. This is important as these professionals would know how to interpret and assess patients’ medical data and health vitals.
• The greater the qualification, the better it would be in terms of quality of care. Providers ordering RPM services may also use software for healthcare analytics as part of the program to better interpret the health data.
• The patients should be monitored through remote monitoring devices for at least 16 every billing period. This is because doing so generates reliable data for providers to make an informed decision on patient health. Any period lesser than this is considered inconclusive and would generally not warrant care. This is why payers might not consider this for remote patient monitoring reimbursement.
• The medical data or patient vitals need to be synchronized for evaluation by providers. The data generated from devices must be stored centrally and coherently.
• Every device used for the remote patient monitoring program must adhere to the definition of a medical device stipulated by the FDA (Food and Drug Administration). This means that the devices used must comply with regulations for the data acquired to be valid and actionable.
• The device used to measure vitals must be able to upload the data automatically without much intervention by patients. This is important to prevent potential tampering with vital signs. Patients must not be able to self-report.   
• The providers offering RPM services must charge Medicare Part B patients a 20% co-payment.

Conclusion 

The Covid-19 pandemic made sure that RPM is here to stay. An increasing number of payers have been covering the services, but many remain skeptical. However, if more providers offer it, other stakeholders will likely follow suit. For healthcare in the United States, the talk around remote patient monitoring reimbursement could result in a policy shift.  

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