(Updated for 2021)
If your practice is considering adding a remote patient monitoring (RPM) program, you will need to take a number of essential steps in advance to help ensure the success of the new program. These include everything from choosing the RPM system that will drive your program to developing an effective mechanism for educating patients on RPM. There is also the not-so-small matter of understanding how you will get paid for your services. Once you learn the nuts and bolts of remote patient monitoring reimbursement, you may decide to move from considering an RPM program to launching a program as soon as possible.
Here are four things to know about remote patient monitoring reimbursement.
1. Coverage of Remote Patient Monitoring
Remote patient monitoring is covered by Medicare. As of July 2020, it's also covered by 23 state Medicaid programs, according to the Center for Connected Health Policy. The organization also notes that Medicaid programs in Hawaii and New Jersey have laws requiring Medicaid to provide remote patient monitoring reimbursement but lacked an official Medicaid policy.
Numerous commercial payers cover remote patient monitoring within their telehealth coverage policies, albeit with some caveats. The number of commercial payers covering RPM experienced a surge due to the COVID-19 pandemic. While coverage of RPM was on the rise prior to COVID-19, and broader coverage for RPM was anticipated in the coming years, the health crisis accelerated this process. As the Kaiser Family Foundation notes, "… many commercial insurers have voluntarily addressed telemedicine [which includes RPM] in their response to COVID-19, focusing on reducing or eliminating cost sharing, broadening coverage of telemedicine, and expanding in-network telemedicine providers."
2. Getting Paid for Remote Patient Monitoring
What can you expect to get paid for providing remote patient monitoring services? Here's some good news: In 2020, the CPT codes assigned to RPM (discussed below) experienced an overhaul. This has made RPM one of the better reimbursing Medicare care management programs.
Here's how remote patient monitoring reimbursement breaks down using average Medicare reimbursement for 2021:
- Medicare pays $21 for initial patient enrollment into a remote patient monitoring program. This includes setup of an RPM device and the delivering of any necessary patient education on using the device and receiving RPM services.
- Medicare provides a base monthly payment of $64 for monitoring patient data transmitted from the device and ongoing management of the device.
- Medicare provides a monthly payment of $55 for spending 20 minutes communicating with the patient or a caregiver about the transmitted data and any changes to the care management plan.
- Medicare will provide an additional monthly payment of $44 if such communication with a patient or caregiver exceeds 20 minutes but is less than 40 minutes. If communication requires 40 or more minutes, Medicare will provide an additional — and final — monthly payment of $44. There are no additional payments for communication of one hour or more.
When these reimbursements are added together, the amount a single remote patient monitoring patient can earn a practice is up to around $210 per month. More often than not, a practice will typically furnish about 20 minutes of RPM care management per month to a patient, which will bring the total monthly reimbursement to around $120 per Medicare beneficiary.
That's nothing to scoff at. If your practice enrolls just 50 patients into your RPM program and each receives the minimum care management services, that will earn you about $72,000 in annual Medicare remote patient monitoring reimbursement. Even after covering expenses associated, RPM yields significant and — importantly — consistent revenue.
3. Coding for Remote Patient Monitoring
How will you earn those payments? By coding your remote patient monitoring services correctly, of course. Let's briefly examine the CPT codes assigned to RPM.
Most of your remote patient monitoring services will be billed under four codes. These codes are often split into two categories: RPM "service codes" — 99453 and 99454 — and timed RPM "management codes" — 99457 and 99458.
The RPM service codes descriptors are as follows:
- CPT 99453 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
- CPT 99454 — Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
The RPM management codes descriptors are as follows
- CPT 99457 — Remote physiologic monitoring treatment management services, clinical staff/physician/ other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes
- CPT 99458 — Remote physiologic monitoring treatment management services, clinical staff/physician/ other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes
As of 2021, the Centers for Medicare & Medicaid Services (CMS) have made clear that CPT codes 99457 and 99458 can be furnished by clinical staff under the general supervision of the billing provider.
Note: For more detailed information about remote patient monitoring requirements for billing and coding, download this RPM billing guide. If you are looking for information about the original CPT code for billing RPM (99091), including an explanation of why it's a code you probably no longer want to use, check out this quick guide.
4. CMS Guidelines for Remote Patient Monitoring
To reduce the likelihood of claims denials and avoid scrutiny of your billing practices, you must understand the CMS guidelines for remote patient monitoring.
To qualify for reimbursement, CMS expects providers to ensure they follow these remote patient monitoring requirements:
- Charge Medicare Part B patients a 20% percent copayment. Note: While routinely waiving copays can trigger federal fines, CMS stated that healthcare providers can do so during the COVID-19 crisis to help clinicians care for their patients while mitigating the risk of the spread of the virus.
- Patients must consent — in writing or verbally — to receiving RPM services.
- The RPM service must be ordered by a physician or other "qualified healthcare professional," such as a nurse practitioner, certified nurse specialist, or physician assistant.
- Patients must be monitored for at least 16 days to be applied to a billing period (a requirement to bill for CPT 99454).
- Data can be wirelessly synced for evaluation.
In addition, CMS stipulates that RPM devices must meet the U.S. Food and Drug Administration's definition of a medical device.
CMS indicated it intended to clarify remote patient monitoring requirements and regulations in 2020 and 2021 but did not do so. We expect more details on what qualifies as an RPM service in the near future, although we would not be surprised if this waited until after the pandemic — or at least the worst of it — is behind us.
Keeping More of Your Remote Patient Monitoring Reimbursement
While remote patient monitoring can serve as a great income-generator for your practice, that will only be the case if you can keep expenses associated with running the program to a minimum. This is one of the areas that the Prevounce Remote Patient Monitoring system shines.
With Prevounce, setup, integration, and ongoing management of an RPM program, including coding and billing for services, is easy and fast. We might be biased, but we think there's no simpler or more effective way to launch an RPM program. Interested in learning more? Schedule a no-obligation demo of Prevounce Remote Patient Monitoring. If you're not ready for a demo, call (800) 618-7738 to speak with a Prevounce customer service representative. We're standing by, ready to help your practice take the next steps toward launching its RPM program.
For more information on remote patient monitoring, see this comprehensive guide.