CMS Remote Patient Monitoring Reimbursements: Guide To CPT Codes and More

Remote patient monitoring, or RPM, enables physicians to observe patients’ health outside conventional clinical environments. The patients enrolled in such a care program use devices to measure their vital signs like heart rate, ECG (electrocardiogram), and blood pressure, among others. They do so at home or elsewhere and remotely share the readings with their providers. Providers assess this data to offer diagnoses and prescribe treatments. Codes for CMS remote patient monitoring reimbursement enable more people to access this healthcare service.    

Centers for Medicare and Medicaid Services (CMS) covers RPM services under certain circumstances. Providers seeking remote services must meet the stipulated criteria to be reimbursed adequately. The Covid-19 pandemic prompted policymakers to make RPM codes a priority. They enable providers to serve patients without needing in-person visits and help all the stakeholders in the process.   

We will discuss more CMS remote patient monitoring and how providers would be reimbursed as telehealth solutions become more mainstream. But first, it is necessary to know how providers can stand to serve their patients better by offering remote patient monitoring services. 

Reasons For Providers To Offer RPM Services  

1. Increased Patient Count  

One of the most obvious advantages of offering telehealth services is the increase in the number of patients. Needless to point out, when patients can receive care remotely and won’t need to come in person as often, they are bound to stick to one physician. Additionally, as RPM CMS codes explicitly state the conditions for reimbursement, providers can rest assured that they will be adequately reimbursed.   

From the patients’ view, a remote patient monitoring program enables them to access specialist care from distant locations. This is especially helpful for people living away from urban locations lacking healthcare facilities.

2. Better Patient Involvement  

Whether a patient is covered by private insurance or Medicaid and Medicare services, they tend to be more involved in RPM programs. They would be responsible for measuring their vitals and sharing them with providers. So they would be more aware of their day-to-day health situation. In the case of remote chronic care management, greater patient involvement directly results in them taking their treatment more seriously. In addition to chronic conditions, people suffering from other less serious diseases would benefit from greater involvement. 

3. Comprehensive Patient Data  

The applications that gather and share patient vitals from RPM devices can be integrated with EHR systems and practice management solutions. This uploads patients’ health data directly to their health records regularly. Providers will better understand the patient’s health situation from such comprehensive clinical information. It facilitates better healthcare management as doctors can make informed treatment decisions.   

An added advantage of having regular patient data is the ability to deploy medical informatics solutions for assessment. These solutions garner important insights about patient health and even help providers determine who is at higher risk. It might even help pave the way for a predictive approach to patient care.

How do Remote Patient Monitoring Reimbursements Work?

With the introduction of new Codes for CMS remote patient monitoring in 2020, RPM reimbursements quickly became one of the most profitable revenue cycle management  options in the healthcare industry. Remote patient monitoring medicaid and medicare programs were spread across 34 states. Even private payers started to offer reimbursement for RPM services. 

Current scenario sheds light on how healthcare remote patient monitoring CMS works. Providers get paid for RPM patient setup and training. This is followed by a fixed monthly amount for managing patient monitoring devices and recording readings. Moreover, this reimbursement also includes the time spent by providers each month to deliver proper care management. Altogether, providers offering quality care through cms remote patient monitoring app or solutions can get fully reimbursed if they fulfill all requirements or comply with CMS guidelines.

Codes For CMS Remote Patient Monitoring Reimbursements  

The number of payers covering RPM services is steadily increasing despite some having mixed feelings. But Medicaid and Medicare cover them under specific circumstances. So, providers need to know the reimbursement criteria for providing remote medical services. The CMS RPM codes outline these conditions; any violations will result in denials and rejections. Let’s look at them in detail – 

1. Code 99453  

This CMS remote patient monitoring code covers the initial cost of setting up the physical infrastructure for RPM. Additionally, it also covers the costs involved in onboarding patients.   

The billing requirements include a prescription by a physician, patient data collection for sixteen days, the use of FDA-approved devices, and service management by certified medical professionals.

2. Code 99454  

This code reimburses providers for supplying people with RPM devices for home health care. Moreover, it also covers related services like installation and programming the devices to collect patient health data. The billing stipulations state that physicians must supply the devices without additional cost and that patients must not be permitted to use their own devices.

3. Code 99457  

This code for CMS remote patient monitoring reimburses healthcare providers or auxiliary staff for their time spent on the services. They include observing, analyzing, and reviewing patients’ vitals remotely. The billing needs to be conducted once a month for 99457.  

Additional requirements include a minimum of 20 minutes per month in the time given for remote monitoring of patients. Furthermore, providers are also required to provide at least one live patient interaction. The interaction may be through multiple mediums, including phone calls, video chats, or in-person consultations. This is done using telemedicine software integrated with health information systems. This enables electronic data interchange, allowing physicians to offer remote services efficiently. Providers billing for 99457 must provide CMS with each patient’s treatment plan.

4. Code 99458  

This code adds to the 99457 to cover each 20-minute block over the stipulated time. This is used for billing as per medical necessity since providers can only bill for 99458 as an add-on to 99457. However, they cannot bill for 99458 independently.

5. Code 99091

This code is for physicians who spend time reviewing the patients’ data from RPM devices. It is to be noted that 99091 can only be billed when physicians spend extra time assessing patient data and not the auxiliary clinical staff. The providers must dedicate at least 30 minutes to assessing patients’ data over a 30-day billing period. These are some of the main codes RPM services must bill for to obtain reimbursement from CMS. 

Guidelines Levied by CMS for RPM

CMS has curated some fundamental guidelines to ensure proper reimbursement for remote patient monitoring. And adhering to these will potentially minimize denials and scrutiny of your practice. Take a look at these guidelines- 

CMS expects practices offering remote patient monitoring medicare and medicaid services to comply with these requirements. 

• Practices must charge 20% copayment from Medicare Part B patients. It’s a non-waivable payment but it can be covered if the patient has supplemental coverage or Medicaid. 
• It’s a must on patients’ part to submit a declaration, in writing or verbally, about receiving RPM care services. 
• CMS RPM services reimbursement is possible if a physician or qualified healthcare professional like a nurse practitioner has ordered RPM services. 
• A minimum of 16 days monitoring period is must for the patient to apply for billing. However, this requirement is specifically for CPT 99454. 
•  Patient health data must be synced wirelessly for evaluation.

Apart from these guidelines, CMS reimbursement for remote patient monitoring is possible only if medical devices used are FDA approved. 

How to Optimize Cash Flow Through RPM?

Generating revenue through RPM services isn’t a daunting task anymore. It’s simple and quick to achieve. Ensuring CMS compliance for remote patient monitoring is essential for providers to get maximum reimbursement for their services. 

Let’s understand how providers can ensure RPM services compliance with CMS- 

1. Opting for appropriate RPM software

It’s crucial to carefully select your RPM software, considering CMS compliance. Providers need to watch out for essential features which help in ensuring compliance with CMS. And appropriate software means better and comprehensive patient care. As a custom RPM development company, we suggest opting for a remote therapeutic monitoring CMS software that provides seamless communication and operations is suitable for best patient outcomes. Also, such a robust software is effective for a hassle-free RPM billing too. 

2. Selecting the right RPM devices

RPM devices are the heart and soul of the technology. Using FDA approved devices that accurately tracks physiologic data of patients is extremely necessary for RPM. Moreover, these devices must ensure patients can use these without any complication and are thoroughly engaged, giving them the best experience.  

3. Targeting the right set of patients 

Ideally, patients with more than six months of chronic illness are eligible for RPM. Patient engagement in CMS remote patient monitoring is essential. And for that, the right patients need to be targeted. Patients with acute or chronic conditions such as diabetes, hypertension, kidney failure and so on are perfect for RPM CCM services. 

4. Outsourcing 

Providing remote care to patients isn’t easy as it may sound. It’s not a job of one person but a proper care team. And if providers can build a team then they can outsource one. They can outsource a care team that will handle multiple tasks related to patients. Delegating tasks such as documentation of patient data, obtaining patient consent, setting up and onboarding patients on the RPM system, and supplying RPM devices to patients can be easily outsourced at affordable costs.

Who Should Provide RPM Services?  

Although remote patient monitoring CPT codes outline the criteria for reimbursement, not all providers would be suited to offer these services. As the name indicates, remote patient monitoring involves tracking patient health over some time to watch out for symptoms. This means that providers who offer care for conditions that don’t require hospitalizations or only need a single course of medications won’t be suited for RPM.  

The best candidates for RPM services are those who treat acute or chronic conditions. Additionally, providers who care for seniors would also be able to reap the benefits of CMS remote patient monitoring codes. Doctors providing such services would need to supply RPM devices and teach patients to use them. Moreover, they would also need to spend time monitoring patients’ vitals to be able to provide treatments. This makes them the ideal candidate to offer RPM services. They could rest assured that CMS would reimburse their services.  

Conclusion 

The Covid-19 pandemic catalyzed the coverage of RPM services since people needed to access care remotely. Codes for CMS remote patient monitoring were a necessary first step toward the wider adoption of remote care services. Providers aiming to offer them must be mindful of their patient population before launching. With increasing investments in RPM technology, we can expect more and more providers to be able to step up and offer these services.

Reference :