August 21, 2020

Using RPM and getting reimbursed from CMS

How to Use Remote Patient Monitoring and Get CMS Reimbursement

Remote patient monitoring (RPM) has leaped into the spotlight since the COVID-19 pandemic. Though versions of RPM have been around since the 1970s, the Centers for Medicare and Medicaid Services (CMS) didn’t fully reimburse providers for even a few of these critically needed services until 2019.

In January 2020, CMS created more billing codes that allow healthcare providers to extend their use of remote monitoring to more situations.

If you are a provider who wants to offer RPM to your patients, there are several guidelines you need to follow to ensure complete compliance.

However, to take full advantage of these developments and reduce risk, providers need to follow CMS guidelines as they use remote monitoring and apply for reimbursement. Here’s a quick guide to help your practice implement RPM for your Medicare and Medicaid patients.

Choose the Right RPM Tools

First, consider your patients’ needs. Often, seniors receiving Medicare coverage won’t have the technological savvy to learn how to use complicated technology. The more seamless the monitoring procedure, the more likely they’ll keep up with their prescribed regimen.

Simplify to ensure compliance

All too many RPM technology companies provide only devices that need a smartphone app to work. That’s one step more than many seniors can handle.

When they become frustrated, they stop monitoring their condition. Non-compliance, in turn, gives rise to hospital readmissions.

You won’t receive reimbursement if they don’t monitor. And, if you’re affiliated with a hospital, CMS might penalize your hospital if readmissions rise above a specific number.

Why take those risks? When you choose an app-free RPM system, it’s a game-changer when it comes to compliance.

Delegate administration tasks to streamline your workflow

Since your main focus is patient care, choose an RPM provider that takes care of administrative tasks for you. You can save money and time when you outsource administrative tasks such as:

  • Obtaining your patients’ consent
  • Creating patient records
  • Onboarding your patients and staff
  • Shipping monitoring devices to your patients
  • Reviewing patient data to ensure compliance with CMS’s billing requirements

Get Your RPM Program Up and Running

Once you’ve chosen your RPM provider, you can identify which of your patients could benefit from remote monitoring. Patients with chronic conditions that once required regular in-person check-ins, such as diabetes, hypertension, and certain cardiac issues, are all good candidates for RPM.

Check your state regulations and insurance provider to see if you need an upgrade in your malpractice coverage for RPM. Make sure that all staff are on board with their roles and that your RPM services provider has adequate support in place should technical issues occur.

Here’s a rundown of how to use RPM once you have everything in place:

  • Prescribe RPM for patients who could benefit: Since most in-person visits for chronic conditions involve taking physiologic measurements, remote monitoring and intervention can help reduce time-consuming in-office routine care. Patients who have difficulty coming to the office because of distance or risk of contracting communicable diseases are all excellent candidates.
  • Set up your patients for monitoring: If your RPM provider doesn’t handle it, you’ll need to obtain your patients’ consent, teach them how to operate their monitoring devices, and provide them with their monitoring devices.
  • Schedule regular monitoring check-ins: Let your patients know when they need to take their measurements. Make sure they know how to get help in case they have difficulties with the process.
  • Keep an eye on your patients’ data: Most RPM systems, including Medek, send data to a HIPAA-compliant portal. You’ll have a dashboard on which you can look at your patients’ current results, history, trends, and review their care plan, in case the data indicates that you should make a change.

A Medek RPM system provides you with results in real-time, allowing you to make medication and other changes quickly. In addition, our medical staff reviews your patients’ data, freeing your staff to spend more time with patients with more pressing issues.

Comply with CMS Rules to Ensure Reimbursement

To receive reimbursement, you must adhere to the specifications CMS outlines for each service rendered. The CPT codes define the parameters you need to cover to meet their requirements.

Figure 1:

CPT CodeService DescriptionNotes
99453Sets the parameters for RPM measurements, including weight, blood pressure, pulse oximetry, respiratory flow rate, and other routine measurements. It also covers the hardware and software setup process and patient education on how to conduct each measurement.There is no work relative value unit (wRVU) assigned, nor is there any requirement for practitioner work to bill for these services.
99454Provides guidelines for supplying the monitoring device, daily recordings, with a focus on the devices used, as well as on guidelines involving daily recordings or programmed alerts every 20 days.There is no work relative value unit (wRVU) assigned, nor is there any requirement for practitioner work to bill for these services. The device that you use to measure and transmit your patient’s physiologic data or create alerts if issues arise must in good working condition and be able to process the data without error.
99457Sets parameters for the initial 20 minutes of RPM treatment services that arise from physiologic monitoring results during one calendar month. Treatment services must be rendered by a physician, clinical staff member, or another qualified healthcare provider.  These services must require interactive communication with the patient or their caregiver.The supervising physician or practitioner does not need to be the same person administering the patient’s treatment in general. You do, however, need to bill this code using the national Provider Identifier (NPI) practitioner or supervising physician need not be the same professional administering treatment to the patient in general. However, CPT 99457 and 99458 need to be billed using the National Provider Identifier (NPI) of the practitioner or physician supervising the staff that provides the service.
99458If the treatment services arising from physiologic monitoring results require an additional 20 minutes, CMS specifies that practitioners use this code for each 20-minute period.The supervising physician or practitioner does not need to be the same person that is administering the patient’s treatment in general. You do, however, need to bill this code using the National Provider Identifier (NPI) practitioner or supervising physician need not be the same professional administering treatment to the patient in general. However, CPT 99457 and 99458 need to be billed using the National Provider Identifier (NPI) of the practitioner or physician that is supervising the staff that provides the service.

Documentation that you met the criteria for each service is essential for receiving reimbursement. Additionally, you must meet the following general requirements:

  • A face-to-face visit: Patients who have not had a face-to-face visit for a year, and new patients must have such a visit before remote monitoring can begin.
  • Patient consent: Providers must obtain consent from each patient before RPM begins. We strongly advise that providers document each patient’s consent.
  • Physician’s or practitioner’s orders: Either a physician or a non-physician practitioner must order RPM. Again, you must document the provider’s order in the patient’s records.

The more routine measurement and administrative services that you can outsource to your RPM platform provider, the more time you can spend with patients with more critical needs. Accurate, error-free, well-documented measurement and records are essential for receiving reimbursement from CMS.

Medek (MedekRPM.com) provides healthcare practices with a full-service RPM platform designed to improve patients’ health through accurate measurement, real-time reporting, and a robust, intuitive interface. It increases billing revenues with thorough patient data reviews to ensure you meet the CMS’s requirements and an automated system that sends your billers all you need to get your reimbursement. To request a full product demo, get in touch with the Medek team today.

Darrayl L. Miles

Vice President of Marketing