An Ounce of Prevention
Whether your practice is already delivering or is planning to deliver RPM services to Medicare and/or Medicaid patients this year, you must understand the CMS rules for remote patient monitoring services in 2020. Without this knowledge, you run the risk of not getting paid appropriately for remote patient monitoring by CMS (Centers for Medicare & Medicaid Services) and possibly running afoul of requirements that can jeopardize your reimbursement and lead to regulatory headaches. To help ensure you receive appropriate and timely payments for remote patient monitoring from CMS and avoid legal scrutiny for RPM services, here are three key things to know.
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Is your practice looking to help your patients stay healthy and reduce their expenses while generating consistent revenue? Then you're going to want to strongly consider providing remote patient monitoring services. Remote patient monitoring, or RPM, is a form of virtual care technology that is receiving tremendous attention and increased adoption during the COVID-19 pandemic, and rightfully so. Remote patient monitoring allows healthcare providers to monitor and electronically capture medical and other health data from patients for assessment, recommendations, and instructions. As a virtual care technology, this collection of health data, which can include blood pressure, vital signs, weight, heart rate, and blood sugar levels, can occur anywhere but the practice. As long as patients are not in a shared space with the healthcare provider delivering the remote patient monitoring services, they can receive these services. This means a patient can be in their home, in an office, on vacation, in a skilled nursing facility, or any other location. Remote patient monitoring is lucrative for practices, being embraced by patients and payers, and likely to play a significant role in the delivery of healthcare going forward — something these RPM, virtual care, and telehealth stats prove all too well. Note: We’ll be regularly adding new statistics to this resource, so bookmark the page and check back regularly!
The story below provides a brief overview of this breaking news. If you are interested in a more in-depth discussion and analysis, you can watch a recent webinar we hosted on the topic here. The Centers for Medicare & Medicaid Services (CMS) has released its 2021 Medicare physician fee schedule proposed rule, which includes many proposed changes to remote patient monitoring (RPM).
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.
In a recent Medical Economics column, I shared some of the most significant updates concerning remote patient monitoring (RPM). Among them: Remote patient monitoring is now one of the more lucrative Medicare care management programs, thanks to an overhaul of the RPM CPT codes (99453, 99454, 99457, and 99458). Medicare is making it easier for practices to provide RPM services, and private payer coverage of RPM is growing. The COVID-19 pandemic has helped drive adoption and use of remote patient monitoring devices in healthcare. A rapidly growing number of patients are interested in virtual care services like RPM, their interest fueled by the health crisis. The column concluded by asserting that the stars have aligned for remote patient monitoring, and it is an optimal time to consider launching or growing RPM programs. Another motivating factor for practices is that they now have several choices of remote patient monitoring medical devices to offer patients and include in their programs. From these options, practices can select the devices that will best meet the short- and long-term care needs of their patients and maximize RPM programs’ revenue potential.
Thanks to an overhaul of CPT codes in 2020, remote patient monitoring (RPM) became one of the more lucrative Medicare care management programs essentially overnight. If 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, that will generate annual reimbursement approaching $150,000. One of the most important steps practices must complete to capture this reimbursement is proper coding of their remote patient monitoring services. This Prevounce Quick Guide outlines the current remote patient monitoring CPT codes and shares some tips for proper RPM coding.
Before 2020, remote patient home monitoring, also known as remote patient monitoring or RPM, was starting to generate some buzz. Healthcare providers were increasingly assessing the function that such virtual technology should play in the delivery of care. Pundits generally agreed that virtual care would eventually take on a significant role but that it would require some time before providers, payers, and patients fully embraced the concept. Then COVID-19 arrived, and virtual care became an essential service seemingly overnight. Now virtual care technology, including remote patient home monitoring, is expected to "redefine healthcare and public health," notes Healthcare IT News. This article includes some eye-opening statistics: The consulting firm McKinsey suggests that $250 billion in healthcare spending could shift to virtual care models and FAIR Health data indicates that telehealth claim lines increased more than 4,000% nationally from March 2019 to March 2020, growing from about 0.17% of medical claim lines to more than 7.5% over that period. The author of the column—who oversees a technology consulting firm —believes that 80 to 90% of all outpatient visits could eventually become "virtualized" in some fashion. Suffice it to say, remote patient home monitoring is not only here, but here to stay. Healthcare practices nationwide are exploring how to incorporate remote patient home monitoring into their services. The good news is that it is a great time to launch a remote patient home monitoring program. In 2020, remote patient monitoring CPT codes (99453, 99454, 99457, and 99458) were overhauled. This made RPM one of the most lucrative Medicare care management programs. Commercial payers are increasingly covering remote patient home monitoring (some by choice, some forced by law). And consumers are rapidly embracing virtual care technology and finding tremendous satisfaction with the experience.
Thinking about investing in a remote patient monitoring system (i.e., software and connected patient devices) for your practice? You're like many practices these days. Remote patient monitoring, or RPM, was already gaining popularity before the COVID-19 health crisis. This can be attributed, in part, to the 2020 changes to CPT codes that propelled RPM into the spotlight as the most lucrative Medicare care-management program as well as providers increasingly embracing technology to support the health and wellness of their patients. When the pandemic hit, the value of providing remote patient monitoring services to patients who were expected to reduce travel and direct contact with others became even more apparent. The federal government recognized this as well, which is why it permanently expanded Medicare coverage of RPM services from just those with chronic conditions to those with chronic and/or acute conditions, among other changes that supported the expanded use of RPM. The future of virtual health services like remote patient monitoring is brighter than ever. Federal and commercial payers are supporting them, and patients are looking for them. Now it's up to practices to meet the demand. With the RPM industry growing, practices have an increasing number of remote patient monitoring system options to choose from. Making an informed decision on which remote patient monitoring system to invest in may prove the difference between whether an RPM program, which includes the software and services provided using it, successfully meets patient and practice needs or if the investment is one that a practice regrets. Before choosing a remote patient monitoring system, answer these five questions.
The COVID-19 pandemic has placed a spotlight on the value of digital health and its ability to effectively engage patients and deliver care. The widespread adoption of digital health is likely to change the way healthcare is delivered here in the United States after the health crisis is behind us. While not a new concept, one of the most exciting changes is the increasing usage of new remote patient monitoring (RPM) technologies. In an effort to keep the most vulnerable patients healthy amidst social distancing guidelines, practitioners and insurers like Medicare are finding that RPM technology offers a good solution to keeping patients with chronic health conditions home and safe while still effectively monitoring their disease progression.