If you are a hospital, you may be wondering how to bill for remote patient monitoring. The reimbursement structure for this type of service is not very clear. There are two types of codes: CPT and Practice expense only. The reimbursement for service, like remote blood pressure monitoring, is governed by Medicare rules. In addition, there are some hurdles that providers must overcome.
Medicare rules
The final rule governing the reimbursement of remote patient monitoring services has finally been published by the Center for Medicare and Medicaid Services (CMS). The proposed rule was greeted with mixed reactions from healthcare providers and remote patient monitoring advocates. While some of the concerns were addressed in the final rule, others remain unresolved. Despite the mixed response, Medicare will still pay for remote patient monitoring services.
The final rule includes changes to RPM codes that are designed to enhance the use of these services, while strengthening their ability to drive revenue and improve quality of care. The new rules allow providers to bill for RPM services once every 30 days, as long as the patient submits data over a 16-day period. Additionally, providers are not restricted to billing for more than 20 minutes of remote monitoring at a time.
The final rule also includes several significant changes to the Medicare rules for remote blood pressure monitoring, such as expanding the coverage of non-interactive service time to 20 minutes. This decision shows that CMS is committed to RPM as a way to increase patient engagement and growth. However, it does not include the inclusion of general device codes.
Remote patient monitoring is a relatively new concept in the healthcare industry. However, it offers valuable incentives for providers and patients. CMS may revisit its rules for remote patient monitoring in the future, and the technology and software will continue to evolve. For now, it is unclear how these rules will affect providers. In the meantime, however, CMS is taking steps to make these services more accessible to patients.
The final rule governing the remote monitoring process for Medicare Part A and Part B services will be available in a few months. The fact sheet also reiterates the two-day measurement-day waiver. However, it is worth noting that this waiver applies only to patients with suspected or confirmed COVID-19.
CPT codes
CMS has recently introduced five primary CPT codes for remote patient monitoring. These CPT codes are intended to encourage remote patient monitoring and provide providers with a new revenue stream. These codes cover an initial supply of a remote monitoring device and its ongoing servicing. In addition, these new codes can help providers alleviate some of the logistical challenges associated with remote patient monitoring.
These updates to the CPT codes have been made to better align reimbursement with the new requirements for remote patient monitoring. If providers do not properly code these services, they could risk financial losses. In the meantime, RPM is a promising revenue stream for healthcare organizations. If properly coded, this service could result in significant reimbursement.
Remote patient monitoring is essential to patient health and reporting. For that reason, healthcare providers and organizations should create a billing model that supports updated CPT codes. In addition, these services should be performed by qualified healthcare professionals, rather than by external providers. Ideally, remote monitoring services will be conducted by staff from one facility, or an external partner like GatewayMD.
CPT codes for remote patient monitoring can help providers increase revenue while also delivering high-quality patient care. In addition, these codes have a growing demand. CMS has also expanded the number of codes for RPM to support providers responding to this growing need.
With these new codes, billing for remote patient monitoring services will become easier. Remote monitoring services can be an excellent way to improve patient care, address gaps in care, and improve patient satisfaction. If you're a medical provider who offers remote patient monitoring services, you'll want to check with your payer and make sure you are reimbursed properly.
Practice expense only codes
Remote patient monitoring is a new trend in medicine that is gaining popularity. CMS has recently made it easier for hospitals to bill for these services with CPT codes. These codes help providers create a revenue model for small and medium medical practices. This type of service can be helpful to both doctors and patients as it can help them understand costs and reimbursements.
Remote patient monitoring devices allow doctors to monitor and collect physiological data from patients. Remote patient monitoring devices are a direct practice expense input code, so healthcare providers should contact a certified billing professional to determine if they are eligible to bill Medicare for this service. To qualify for reimbursement, healthcare providers must transmit data from the device for at least 16 days during any 30-day period.
In the past few years, the Centers for Medicare and Medicaid Services (CMS) have expanded their reimbursement codes for this service. The new policies are effective as of January of this year. They include both temporary and permanent reimbursement for providers of remote patient monitoring. However, practices must be careful to correctly code remote patient monitoring services.
While remote patient monitoring may not seem like a big deal, the CMS allows physicians to bill the cost of the service through CPT codes. This includes time spent in setting up the system and training the patient to use it. This CPT code (99453) is worth up to $19 and billed only once for each patient. Another code, 99458, allows physicians to bill for additional 20-minute intervals.
Telehealth waiver
When establishing a Telehealth waiver for remote patient monitoring, a healthcare organization should carefully consider which patient population it would like to reach. Different target patient populations require different telehealth solutions and support services. A flexible approach is essential for the program to succeed. In addition to identifying patient population groups, a health organization should also consider whether it has the infrastructure to handle telehealth services. Hiring a turnkey servicing solution like GatewayMD will reduce overall workload for you and your organization.
Remote blood pressure monitoring services are covered by several health insurance plans, but providers must make sure the service is appropriate for the patient and is in the scope of practice. Many states require providers to verify the patient's identity before providing the service. In addition, providers must ensure that their services are private and secure.
The OIG is particularly focused on telehealth. It has a detailed work plan detailing the scope of its ongoing audits and inspections. The plan can help clients know what the agency is focusing on. Currently, the OIG has eight telehealth audits and inspections in progress. One of these is Medicare Telehealth Services During the COVID-19 Pandemic, and it expects to release a report later this year.
Despite the fact that there are many restrictions on telehealth, the federal government does allow rural health clinics to be distant sites for remote patient monitoring. Additionally, remote patient monitoring can be provided by federally qualified health centers or rural health clinics. The program also allows practitioners with specialized skills, such as occupational therapists, to conduct telehealth sessions. But this requires legislation.
Remote patient monitoring is an essential part of the healthcare system and can be used to track patients between formal interactions with the health care system. Regular monitoring of vital signs and other health data can lead to early intervention and disease management, reducing the number of unnecessary emergency room visits and hospitalizations.
Costs
Costs of remote patient monitoring can vary from hospital to hospital, depending on the type and size of the population. For example, one provider may be able to monitor up to 100 patients, while another might only monitor a few patients. However, both types of costs will be higher than traditional RPM.
CMS has begun establishing payment in 2019 for three separate codes - "Chronic Care Remote Physiologic Monitoring." These codes cover initial setup, patient education, and remote monitoring of physiologic parameters. Additionally, healthcare providers can bill for supplies and data transmission on a monthly basis.
One of the major concerns about the cost of Remote Patient Monitoring is whether or not the service is cost-effective. A good program will incorporate analytics to ensure continuous improvement and reduce overall costs. The reporting tool should also be capable of delivering digestible data visualizations and printable PDFs. This will enable healthcare providers to better manage the costs of this service.
Remote patient monitoring can also reduce costs for healthcare providers by helping them reduce the number of hospital readmissions. In addition, it can help reduce COVID-19 exposure. Many healthcare providers are now implementing the strategy. It allows them to keep a constant tab on their patients and coordinate with home healthcare providers.