How to Increase Practice Revenue with Remote Patient Monitoring
Medical practices and health systems are looking to embrace remote patient monitoring as a way to provide convenient care delivery. Recent policy changes by The Centers for Medicare and Medicaid Services have expanded coverage for the platform making it easier for patients to get the care they need while providing a big revenue opportunity for your practice.
What is remote patient monitoring?
Remote patient monitoring allows providers to use connected electronic devices to manage certain aspects of their patient's health while cutting down on patients' travel costs and risk of infection. Remote patient monitoring can be used to provide care for both acute and chronic conditions and has become an increasingly popular care option.
Historically, services that are paid under the Medicare physician fee schedule had to be provided in person and the physician had to be in the room in order to be able to bill them.
Starting in 2019, CMS started to recognize that there was a benefit to allowing physicians to remotely collect and analyze patient data in order to provide quality care. CMS decided to change its policy to allow payment for remote evaluation or virtual check-ins with their doctor. These virtual visits are not considered to be a telehealth service making them exempt from previous Medicare payment restrictions.
Most remote patient monitoring services will be billed under four CPT codes. These codes are frequently split into two categories: RPM service codes and timed RPM management codes
The four primary CPT codes for remote patient monitoring are:
CPT 99453 – Initial device setup and patient education
CPT 99454 – Remote monitoring of patient data, every 30 days
CPT 99457 – RPM requiring interactive communication - first 20 minutes
CPT 99458 – RPM requiring interactive communication - each additional 20 minutes
Nationally-unadjusted, non-facility payment rates
Over the past four years the payment rates have dropped slightly for some of these services, but there's still a significant revenue opportunity if these are the kinds of services that your practice provides.
What are the requirements for remote patient monitoring?
Before you start billing for remote patient monitoring, here's a few things to remember.
Patient care must involve work separate from an office visit and should not be billed with E/M code(s).
The device used for remote monitoring must be a medical device approved by the FDA
Service must be ordered by a physician or other qualified healthcare professional
Always code to the highest level of specificity
Remote evaluations can be reported during the same service period as other care management codes, but you cannot report the same time for multiple codes
These visits require live interactive communication
Only report code 99457 once per month, use code 99458 for each additional 20 minutes
Do not report code 99457 for less than 20 minutes of service
Benefits of remote patient monitoring
A 2019 study from the Consumer Technology Association surveyed healthcare professionals and patients to determine the perceived benefits of remote patient monitoring. The healthcare professionals surveyed said the biggest benefits of using connected to technology to manage health are improved patient outcomes (49%), improved compliance rates (44%) and patients taking more responsibility for their health.
For patients who participated in the study, the top three benefits are detailed information to personal health information (43%), faster access to healthcare services (42%) and more influence on their own well-being due to feeling a sense of ownership of their health data (37%).
More than half of the patients surveyed also indicated that they would use a remote monitoring device as part of their treatment if a doctor suggested it.
What are remote patient monitoring devices?
There are four common remote patient monitoring devices that practices should consider before starting a RPM program.
Blood pressure monitor - Providers can keep track of blood pressure using cuffs on patient's wrists to improve hypertension management. The American Heart Association says research has shown that remote cardiac monitoring can drastically reduce patient blood pressure compared to self-monitoring.
Weight monitor - Practices can use connected scales to monitor weight for patients who may be at risk for congestive heart failure. For patients working to lose weight, ongoing monitoring can help illustrate trends and measure success.
Blood glucose monitor - Watching blood glucose levels is important to keep patients with diabetes safe. Glucose monitoring can be performed using various remote patient monitoring devices, including some that do not require patients to draw blood.
Spirometer - Remote spirometry lets providers monitor a patient's lung condition to determine whether treatments like medication can be successful in helping to manage breathing issues. The COVID-19 pandemic greatly contributed to the increase in remote lung function monitoring for patients with respiratory risks.
Is remote patient monitoring worth it?
Changes by CMS to rules and reimbursement guidelines have allowed remote patient monitoring to expand and grow in popularity. As of April 2022, 30 states have some form of Medicaid reimbursement for remote patient monitoring in their Medicaid programs.
By providing 20 minutes of remote patient monitoring per month, each Medicare beneficiary can add roughly $1,400 in revenue to your practice over a 12-month period. At that rate, if you have 100 patients enrolled in a remote patient monitoring program your practice can expect to generate a little over $10,500 a month in revenue for care you may already be providing.
Potential revenue on a per patient basis
This example does not include reimbursement you may receive for initial training or for any additional billable time beyond the initial 20 minutes. Just remember, remote monitoring services must meet all coverage requirements and be reasonable and necessary in order to be reimbursed.
Following the proper remote patient monitoring coding and billing rules laid out by CMS is not only crucial to get paid what you deserve but also to ensure you maintain compliance in the event you are audited.
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