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Tips For Remote Patient Monitoring (RPM) Reimbursement


Article-Tips-for-Remote-Patient-Monitoring-(RPM)-Reimbursement

Remote patient monitoring is a method to deliver care with the help of advances of technology to gather patient data outside of traditional healthcare settings. To combat COVID-19, RPM can be a safe and useful method to deliver care.

Moreover, CMS provides some guidelines as well as new CPT codes for remote patient monitoring (RPM) to respond to COVID-19 public health emergency.

Let’s look at these guidelines as well as various CPT codes for reimbursement in detail:

CMS guidelines for Remote Patient Monitoring (RPM) to response COVID-19

Home-based monitoring for symptom escalation can help reduce the risk of transmission especially for patients who test positive for COVID-19. Moreover, as we face a growing hospital bed shortage in the USA, remote patient monitoring can free up valuable and critical hospital resources to treat the most critical cases.

In Response to the COVID-19 Public Health Emergency, CMS issued specific guidance around RPM as part of their “Medicare and Medicaid Programs; Policy and Regulatory Revisions” interim final rule.

The rule talks about CMS coverage for Remote Patient Monitoring (RPM) for the duration of the public health emergency as well as permanent fixes. Moreover, RPM could be used for patients with both acute and/or chronic conditions, not just limited to patients with only chronic conditions.

Apart from various RPM guidelines, CMS have worked to expand RPM reimbursement codes to help providers respond to the growing shift and demand for virtual care services.

CPT codes for Remote Patient Monitoring (RPM) reimbursement

For the reimbursement for physicians and qualified medical professionals, these CPT codes provide a financial structure for the time spent and the equipment used for patient care delivered remotely.

The physicians and other healthcare experts are not responsible for managing the programs alone, but Medicare will pay for the initial equipment setup, the devices required for patient’s education, and ongoing management of remote monitoring programs.

Code

Description

CPT99091

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.

CPT 99453

Initial; set-up and patient education on the use of equipment. This is for the monitoring of parameter(s) such as respiratory flow rate, blood pressure, pulse oximetry, blood pressure).

CPT 99454

Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

CPT 99457

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time. This code requires interactive communication with the patient/caregiver during the month.

CPT99458

Monitoring of remote physiologic that exceeds first 20 minutes of RPM services (for the clinician)

Now, you are aware about various CPT codes for reimbursement.

Let’s try to find out various general requirements of CMS (RPM) reimbursements:

  • CMS  requirements for Remote Patient Monitoring (RPM)  reimbursements

            The healthcare service providers and hospitals need to ensure the following things to qualify for CMS

            reimbursements.

  • Medicare part B patients are imposed 20% of copayment (renouncing the copayments regularly can trigger penalties under the Federal Civil Monetary Penalties Law and also the Anti-Kickback Statute)
  • Patients must take the remote monitoring services and are required to monitor for a minimum of 16 days to be applicable for a billing period.
  • The RPM services must be ordered by skilled physicians or other qualified healthcare experts.
  • Data must be wirelessly synced for proper evaluation, analysis and treatment.

The new CPT codes can help to create a healthcare ecosystem efficiently accessible, standard, empowered with technologies, affordable. Moreover, healthcare experts and patients can stay connected, organizations can get paid for utilizing the trending technologies.  Are you looking for how to utilize CPT codes for reimbursement and build a better patient care model? We can help you.

We are HIPAA compliant medical billing and coding expert and our experts can help you to grow your revenues by getting reimbursed for Remote Patient Monitoring (RPM) services.

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