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Considering Remote Physiologic Monitoring – RPM? Here is what you need to know!

For many practices, partnering with a company offering a full turnkey solution is the best approach!

Remote Physiologic Monitoring (sometimes called Remote Patient Monitoring) improves patient health while generating additional revenues for the practice. RPM is the regular monitoring of medical parameters from the patient’s home, using cellular connected medical devices. CMS created the program and authorized reimbursement a few years ago, allowing claims for these services to be submitted monthly. The program has been modified and clarified since then, including changing the rules to now allow provision of services ‘incident to’ the physician’s direction.

Turnkey vs FULL turnkey? RPM program vendors will provide the devices for patient monitoring, upload the device readings and continuously review the data for anomalies. They will alert the practice when a patient’s readings exceed bounds set by the practice for that patient. They will also call the patient (or caregiver) suggesting repeating a reading if an anomalous reading might indicate measurement error. Unfortunately, many of these vendors expect the physician to access the gathered data through a company portal, leaving patient information scattered.

In a Full turnkey solution, an RPM program vendor also propagates the physiologic records into the patient’s chart within the physician’s own EHR. A billable ‘encounter’ is also created each month in the physician’s practice management system. With these solutions, the patient RPM information is available in the same place as is all other patient information, and claim submission and billing occur just as if you had provided the services in your own office, but without any of the management headaches.

Benefits of RPM:

  • Keeping people healthy – responding to adverse changes before they escalate.
  • Continuous monitoring for post-surgical complications
  • Reducing hospital admissions (and re-admissions)
  • Reducing costs – on patients, physicians, and the overall healthcare system
  • Enabling compromised individuals to live at home longer

Authorized RPM codes/services (2021):

CPT Code Description PFS Avg Payment
99453 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment $19
(one time)
99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each calendar month $63
99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month $51
99458 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes $41

The most common RPM codes claimed are 99454, which is for providing and operating the technology itself, including data transmission, and 99457, which is for 20-39 minutes of time spent in a combination of reviewing patient data and in interactive communication with the patient via phone or video.

Who is allowed to bill for RPM services? RPM is considered an E/M service. The CMS 2021 Final Rule confirmed RPM can be ordered and billed only by physicians or non-physician practitioners who are eligible to bill Medicare for E/M services. For Medicare patients, there would normally be a requirement that there be an established patient-physician relationship. This has been waived during the PHE.

One of the requirements for these codes is that readings be automatically collected and reported electronically. The technology needs of RPM virtually require that an RPM vendor be involved in the tracking and service delivery. If such a vendor is used, virtually all of this effort is performed by the vendor, for which they are paid a fee in the neighborhood of half of what may be collected from Medicare. CMS confirms that practices are allowed to bill for RPM services delivered by these vendors.

Enrollment:

Many of the patients eligible for Chronic Care Management could also benefit from RPM – usually, the physician will identify which of their patients will benefit and then will specify which device(s) are medically appropriate. For patients not on Medicare, the vendor will determine whether their commercial insurance will cover RPM services.
For enrollment, many vendors will reach out directly to patients identified by the doctor, will get patient consent, and then will send the devices to the patient and will train them or their caregiver in proper usage. Others rely on the doctor/staff to obtain consent and to deliver the devices and train the patient.

Devices:

The most common of the devices are BPCs, Scales, Pulse Oximeters, Glucometers and activity/sleep wearables. Some companies will loan the devices without separate charge, for the duration of patient enrollment. Others require the practice to purchase the devices for the patient. (Not many reimbursement options exist for the devices themselves, although some practices charge their enrolled patients a small monthly fee.)

Devices stay in the patient’s home for the duration of their enrollment in the program. Medicare will only reimburse a single physician for RPM services and will reimburse based on minimum monthly usage of any of the devices and time facilitating their use and tracking results and trends. Additional devices do not result in additional reimbursements. Readings must be taken on at least 16 days, on at least one medical device in a calendar month. (For most of 2020, due to the PHE, this number was reduced to just 2 readings. CMS recently revised the PHE exception; 2 readings per calendar month is still sufficient specifically for Covid-19 patients – until April, but this exception is expected to be extended through 2021. For all other patients, the minimum number of days with readings is again 16.)

Some devices connect themselves to the cellular networks. Others use Bluetooth to connect either to the patient’s own smartphone or to a limited use tablet or cell phone which then transmits data over the cellular network. Whichever device connects with the network, data is sent automatically. Measurements manually recorded by the patient or caregiver do not qualify for reimbursement under these RPM codes.

 


 

You can do RPM yourself, but it takes a lot of setup and management, and the reimbursements are not that good. With the right RPM partner, you can still increase net practice revenue with very little of your or your staff’s time, while keeping your patients healthier. Claims are paid directly to your practice and only then do you pay the vendor for doing all the work. If you’d like to learn more, reach out!

 


 

This is the latest in a series of articles about Remote Physiologic/Patient Monitoring (RPM) and the closely related Chronic Care Management (CCM). Others in the series are/will be:

Chronic Care Management: Do it yourself? Contract with a Service? Not enough reimbursement to bother?

What is Chronic Care Management?

How to select a program vendor for RPM and/or CCM services

Service Quality matters with outsourced CCM

You CAN deliver CCM services in Nursing homes – according to CMS!

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