Many healthcare professionals are searching for a transition to remote patient monitoring to improve patient volume, patient involvement, and generating revenue. A remote patient monitoring system offers several advantages, including enhanced patient engagement, revenue streams for medical practices, higher productivity, and improved patient satisfaction, all of these contribute to the practice’s overall success. When combined with automated nurse workflows and smooth reimbursement, remote patient monitoring practices can undoubtedly cause a positive cash flow for medical procedures as long as the right RPM partner is chosen. This article discusses the advantages of remote patient monitoring software in increasing revenue generation.
What is a Remote Patient Monitoring System (RPMS)?
Healthcare is constantly evolving, with new and innovative technologies emerging daily. Remote patient monitoring (RPM) is a significant advancement that provides numerous benefits to the healthcare system. Remote patient monitoring employs cutting-edge telecommunications technology to promptly and efficiently control patient health. RPM reduces the requirement for in-person visits by allowing personalized devices to consistently and accurately grasp an individual’s health-related data. Information is sent immediately to a healthcare professional, who evaluates it virtually. Remote patient monitoring medical devices are equipped with automated sensors and wireless data transmission capabilities, allowing collected data from mobile applications to be easily transmitted to a cloud database and available to healthcare providers at any time.
How Does Remote Patient Monitoring Works?
While RPM methods differ depending on the device or monitored condition, most of the technology includes common elements. First is a wireless-enabled sensor that can measure and store specific physiological parameters. This storage must also be able to communicate with other sensors, healthcare provider databases, and related applications. Applications typically provide users with an interface to track or analyze data and view treatment recommendations.
The information gathered by RPM devices is routed to the appropriate location and stored in a database system. That enables healthcare organizations to examine wireless telecommunication data as individual instances or within the context of whole health history.
How To Bill For Remote Patient Monitoring
There are a few things to remember for healthcare providers who want to bill and receive reimbursement for RPM services. To begin, RPM is a monthly-billed program, and patients must receive a minimum of twenty minutes of service per month to meet the criteria for Medicare reimbursement. This period may include engaging communications, remote monitoring, and data reporting.
RPM services must also be ordered by a physician or qualified healthcare professional. A nurse practitioner, certified nurse specialist, or physician assistant may be included. In some RPM programs, the initial evaluation may be conducted by a care coordinator or nurse, who will then discuss it with a physician for final interpretation and implementation.
The following five items should be kept in mind while filing a claim through CMS:
- CPT codes for each program you manage on behalf of the patient
- Assigning ICD-10 codes to each of the conditions addressed by that program.
- Service date
- Service location
- Provider Name
While it is not required, knowing the care manager assigned to a patient is helpful in case you are ever audited: You will determine how much time is spent with each of your patients monthly when billing.
When billing, you will take the following four steps:
- Each month, check to see if CMS requirements were met for each patient
- Submit claims to CMS monthly.
- Send a monthly invoice to patients who receive CCM services.
- Check for any conflicting codes that have been billed.
CMS Remote Patient Monitoring Guidelines
You must know CMS guidelines for remote patient monitoring to decrease the risk of claim denials and avoid scrutiny of your billing practices.
CMS intends providers to follow the following remote patient monitoring specifications to qualify for reimbursement:
- Patients on Medicare Part B must pay a 20% co-payment.
- Patients must give their written or oral consent to receive RPM services.
- To be applied to a billing period, patients must be monitored for at least 16 days (a requirement to bill for CPT 99454).
- Data can be wirelessly synchronized and analyzed.
CPT Codes for Remote Patient Monitoring (RPM)
These CPT codes provide a financial structure for the time spent and the equipment used for remote patient care delivered by physicians and qualified medical professionals seeking reimbursement. Physicians and other healthcare professionals are not solely responsible for program management, but Medicare will pay for initial equipment setup, patient education devices, and overall maintenance of remote monitoring programs.
CPT codes for remote patient monitoring correspond to specific services provided, such as:
- Initial device configuration
- Patient daily use of an RPM device while providing care
Initially, configuring a device can only be billed once. Daily device usage can also be billed only once per month. Finally, if a patient has taken sixteen daily device readings, daily device use should only be billed on the last calendar day of the month.
Remote Patient Monitoring CPT Codes
|CPT 99453||Initial; setup and patient education on the use of equipment for monitoring parameters(s) such as respiratory flow rate, blood pressure, and pulse oximeter. (one-time fee)||$19.04|
|CPT 99454||Supply of devices, collection, transmission, and summary of services to the clinician. (every 30 days)||$55.72|
|CPT 99091||Collection and interpretation of physiologic data digitally stored and transmitted by the patient or other QHCP require a minimum of 30 minutes.||$56.41|
|CPT 99457||Remote physiologic monitoring services by a physician or other qualified healthcare professional time (20 minutes or more). This code requires interactive communication with the patient during the month.||$50.18|
|CPT 99458||Monitoring of remote physiologic that exceeds the first 20 minutes of RPM services over 30 days.||$40.82|