How to Manage Common Denials for RPM?

Remote Patient Monitoring (RPM) is a health care delivery method that benefits patients, providers, caregivers, and the healthcare system as a whole, by leveraging technology advances to gather patient data, outside of traditional health care delivery settings. From increasing access to virtual care, increased patient-provider communication opportunities, and improved patient involvement in self-management to reducing COVID-19 spread and the overall total cost of care, there are many important benefits of remote patient monitoring. Despite all these benefits, RPM offers unique reimbursement challenges, in light of more specific RPM guidance published in January 2021. So, you should be well versed with payer guidelines and reimbursement policies to manage common denials for RPM. 

Common Denials for RPM

The Monitoring Device Doesn’t Meet Federal Requirements

It’s the common denial received by providers. To avoid such denials, refer to specifications shared by the United States Food and Drug Administration before buying a remote monitoring device. All the devices approved by the federal authority provide automatic data upload and transmission. If at any point you or your patient enters information, that’s not the type of device the government is willing to cover. If physicians are working with a vendor to supply RPM devices and manage the RPM program, they should include a provision in the vendor agreement that the vendor is supplying the practice with a device that meets functionality requirements for RPM under the Medicare Part B program and that it will indemnify the practice for any damages or overpayment recoupment.

Medical Necessity Isn’t Proved

As per basic requirements, you need to use RPM only for patients with an acute or chronic condition that must be monitored. So, your documentation should clearly reflect how remotely monitoring the patient supports the care plan and period of use. Also, if the RPM is for an acute condition, Medicare’s expectation is that the RPM will cease at some point in the short term when it no longer becomes medically necessary.

Less Than 16 Days of RPM Data

Physicians may use multiple devices or a single device that captures more than one type of physiological data. You can pull data from multiple devices to meet the 16-day requirement. Physicians can only bill 99453 once per episode of care and 99454 once every 30 days regardless of how many devices the patient uses. That does not preclude physicians from billing more specific codes when possible. Examples include 95250 for continuous glucose monitoring as well as 99473 and 99474 for self-measured blood pressure monitoring. It can also be helpful to work with a vendor that helps manage your RPM program because the vendor typically reminds patients when to take their readings. 

Submitting a Date Range 

Only submit one date of service for CPT codes 99453 and 99454 even though the codes require at least 16 days of data. For example, practices usually use the first or last day of the month.

Sometimes, it may possible that the insurance carrier or Medicare Administrative Contractor (MAC) might make mistakes and deny your claim. We observed that a lot of private and government carriers have denied claims stating that RPM services must be used only for cardiology services. In such cases, you can simply point out the error and ask them to adjust the denial. 

If you are avoiding using Remote Patient Monitoring (RPM) services due to fear of non-reimbursement then we can assist you. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle solutions for your practice. We are well versed with payer reimbursement policies and documentation guidelines for various payers. To know more about our RPM billing and coding services, contact us at 888-357-3226