Remote Patient Monitoring (RPM) is making its way into mainstream healthcare. The Centers for Medicare and Medicaid Services (CMS) officially published new RPM codes at the end of 2018 that have gone into effect this year.
Understanding these codes and the ways that they incentivize providers to utilize RPM technologies to improve patient care and outcomes can help providers efficiently adopt or expand their use of these technologies to monitor patients. Those able to monitor patients remotely and to navigate RPM technologies and codes are likely to reap significant benefits.
Here are 5 things that each provider should know about RPM and its reimbursement:1. Medicare will pay for the RPM setup process
Though it may seem like an administrative hassle to set up RPM from a technical standpoint as well as from a patient education standpoint, Medicare will pay for the work it takes to get your RPM up and running and to onboard each new patient. The RPM Code CPT 99453 can, for instance, be used for reimbursement relating to the setup of RPM equipment and educating patients on that equipment. The resources required to provide and to receive reimbursement for RPM services should therefore not deter providers from doing so.
2. RPM is not the same as telehealth and is not reimbursed the same way
While telehealth and its corresponding reimbursement focus largely on medical access for patients in rural locations, the goal of RPM is to monitor patients as part of a shift in emphasis toward preventative medicine. The hope is that with better monitoring, risky and costly crisis management interventions can be averted in any patient, regardless of where they reside. Reimbursement therefore does not depend on geography in the case of RPM services but instead simply requires that medical information has been interpreted without the patient and provider having to directly interact. Indeed, more frequent and regular monitoring is possible if data can be transmitted and interpreted without requiring direct patient-provider interaction.3.The threshold for RPM reimbursement has been lowered
RPM reimbursement now extends to services performed by clinical staff and requires less time than it previously did.
The previous RPM billing code, CPT 99091, only covered services performed by physicians and qualified healthcare professionals. The new code, CPT 99457, has expanded the ways in which a medical practice can receive reimbursement for their RPM services by including services performed by clinical staff. Practically speaking, this change means that for the first time, RPM services performed by individuals like medical assistants and RNs can now be reimbursed.
Before this year, CPT 99091 required 30 minutes of services in a 30-day period. The replacement code, CPT 99457, requires instead only 20 minutes in a calendar month. Not only is the time requirement for reimbursement lower, but tracking is simpler because the calendar month aligns with recordkeeping and claims submissions.
4. The new codes are: CPT code 99453, CPT code 99454, and CPT code 99457
The first two codes, CPT code 99453 and CPT code 99454, are for the remote monitoring of parameters such as weight, blood pressure, respiratory flow rate, and pulse oximetry. While CPT code 99453 covers RPM setup and patient education, CPT code 99454 covers daily recordings and transmission of data. CPT code 99457 emphasizes treatment management and requires 20 minutes of interactive communication between a provider or staff member each month.
5. CMS plans to clarify which technologies qualify under the new RPM codes
While there has been speculation about the types of technology that the new RPM codes will cover, CMS has not yet provided specific guidance on which technologies qualify for reimbursement. Though it is likely that Fitbits and other applications that integrate with smart devices will be covered, CMS plans to issue formal guidance in the coming months.
Takeaways: The changes in how CMS reimburses RPM services demonstrate that CMS values RPM and wants to incentivize providers and practices to engage in this type of patient monitoring. As technological capabilities continue to grow, so too will the potential to serve patients remotely and in a data-driven, preventative manner. Learning now how best to provide these services and work with CMS to maximize reimbursement for performing these services will likely prove to be a worthwhile investment with long-term payoffs.