The COVID-19 pandemic rapidly accelerated the need to manage the care of high-risk patients outside typical healthcare settings, forcing providers to rethink traditional care delivery models. Changes to legislation in March 2020 made reimbursement available for Remote Patient Monitoring (RPM), making it more financially feasible to offer these services to patients. The swift adoption of RPM has made it one of the fastest-growing technologies in the healthcare industry. In fact, experts estimate that by 2024 nearly 30 million patients, or 11.2% of the population, will be using RPM. 1
Many hospitals and healthcare providers have embraced RPM for its numerous benefits. A recent survey found that more than three-quarters of hospitals anticipate RPM to match or surpass inpatient within five years. 2 For hospitals, RPM can help improve post-acute care and reduce hospital readmissions. For physicians, RPM can help manage their patient’s chronic conditions, improve patient adherence, increase efficiencies while providing new opportunities for reimbursement. For health insurers, RPM offers a way to improve population health and reduce costs.
The key to ensuring a successful RPM program is preparation, planning and partnering with the right telehealth provider. Below are the top twelve most frequently asked questions and answers regarding remote patient monitoring.
1) What is Remote Patient Monitoring (RPM)?
Remote patient monitoring (RPM) is a healthcare delivery method that uses digital technologies to monitor and analyze a patient’s vitals and other health data outside of a traditional clinical setting. RPM technology electronically transmits health information between patients and physicians. This type of monitoring is often used to manage and care for high-risk patients, such as those with acute or chronic health conditions.
2) Who can provide RPM services?
RPM can be ordered and provided by physicians and other qualified healthcare professionals (QHCPs). Clinical staff can deliver and manage RPM under the general supervision of the billing provider.
3) Who can receive RPM services?
Any patient with a chronic or acute condition may receive RPM services if the provider prescribes/orders RPM and it is relevant to managing the patient’s condition.
4) Can RPM be used for new and established patients?
Yes, CMS allows providers to deliver RPM services to new and established patients for both acute and chronic conditions.
5) What are common examples of RPM devices?
The RPM device must be necessary for the diagnosis or treatment of the patient’s illness or injury. It must or be used to collect and transmit physiologic data that allows the understanding of the patient’s health status to develop and manage a plan of treatment. RPM can employ wireless or wired measurement devices. Some of the most common RPM devices are blood pressure monitors, weight scales, pulse oximeters and blood glucose meters. The RPM device must digitally upload patient physiologic data and cannot be self-recorded or self-reported by the patient to qualify for Medicare.
6) What are common types of patient health data collected with RPM?
Providers may use RPM to collect patient health data, including blood pressure, vital signs, weight, heart rate, blood sugar levels, and physical activity.
7) What are the most common medical specialties that offer remote patient monitoring?
Specialties that utilize RPM include but are not limited to cardiology, pulmonology, endocrinology, gastroenterology, bariatrics, internal medicine and primary care.
8) What disease states can be managed with remote patient monitoring?
Some of the most common disease states that can be managed by RPM include hypertension, obesity, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes.
9) What are some of the benefits of using RPM?
RPM provides a wide range of benefits, including:
- Improved management of acute and chronic conditions
- Reduced hospitalizations and readmissions
- Reduced hospital lengths of stay
- Lowered overall healthcare costs
- Increased patient adherence and engagement
- RPM enables older and at-risk individuals to remain at home longer and delay or avoid moving into skilled nursing facilities
- RPM helps reduce the risk of infectious disease exposure such as COVID-19 for patients, providers and healthcare workers.
10) How is RPM Reimbursed?
The Center for Medicare and Medicaid Services (CMS) has expanded reimbursement opportunities for healthcare providers offering remote patient monitoring (RPM) services. RPM is payable by Medicare and 21 state Medicaid programs (as of January 2021), and an increasing number of private payers. Below are the 2020 RPM Codes and CMS Guidelines for providing RPM services to patients, as well as for staff time spent monitoring these patients:3-4
99453: Initial setup and patient education for the use of monitoring equipment.
99454: Supply of devices and collection, transmission, and summary of services.
99457: First 20 minutes of remote physiologic monitoring management services by clinical staff/physician/QHCP requiring interactive communication with the patient or caregiver. (20 minutes in a month)
99458: For an additional 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP requiring interactive communication. (each additional 20 minutes spent beyond 99457 up to 60 minutes total)
*Medicare covers the following services for both new and established patients with acute or chronic conditions.
*Reimbursement amounts will vary based on Medicare administrative contractors. (MACs)
Example first month billing
RPM CPT CODE Reimbursement
99453 $21.00
99454 $69.00
99457 $54.00
99458 $43.00
REIMBURSEMENT TOTAL $187.00
11) Can RPM be billed in conjunction with chronic care management (CCM)?
Yes, a provider can bill for both CPT 99457 and CPT 99490 in the same month. This is because CMS recognizes that the analysis involved in providing RPM services is complementary to CCM and other care management services. However, time spent delivering these services cannot be counted towards the required time for RPM and CCM codes for a single month. Billing 99457 and 99490 together requires a provider to deliver at least 40 minutes of services: 20 minutes of RPM, 20 minutes of CCM.
CMS Guidelines for RPM
For patients with two or more chronic medical conditions expected to persist for more than 12 months following diagnosis and place the patient at an increased risk for hospitalization.3-4
99487: Minimum of 60 minutes non-face-to-face consultation establishing or monitoring a care plan
99489: For every additional 30 minutes non-face-to-face consultation (with 99487)
99490: Minimum 20 minutes non-face-to-face consultation monitoring the care plan
Example RPM and CCM Billing:
RPM CPT CODE Reimbursement
99457 $54.00
99487 $92.00
99489 $47.00
REIMBURSEMENT TOTAL $193.00
12) Is there a copay associated with RPM services?
Yes. For Medicare beneficiaries, there is a 20% beneficiary copay. However, this copay may be covered if a patient has supplemental coverage or Medicaid. Private payers will vary and may or may not require a copay for RPM services.
About Connect America
For more than 45 years, Connect America has helped aging individuals and at-risk populations live safely and independently in their homes. As North America’s largest independent provider of connected health, Connect America and our family of brands, including Lifeline, deliver a growing portfolio of innovative technologies that help bridge the gap between healthcare providers, individuals, and their care partners. Our easy-to-use solutions support health and safety in a way that leads to enhanced quality of life, earlier interventions, reduced hospitalizations and peace of mind for an estimated 10 million lives every year. Together, we are enabling independence and redefining the global home healthcare market.
References:
1) Remote Patient Monitoring Trends & Health Devices in 2021 (businessinsider.com)
2) More Than Three-Quarters of Hospitals Anticipate Remote Patient Monitoring to Match or Surpass In-Patient Within Five Years (prnewswire.com)
3) managing-patients-remotely-billing-for-digital-and-telehealth-services.pdf (acog.org)
4) Medicare Remote Patient Monitoring Reimbursement FAQs: Everything You Need to Know About Chronic Care Remote Physiologic Monitoring Codes | Blogs | Health Care Law Today | Foley & Lardner LLP