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Everything You Need To Know About RPM Medical Billing

Remote Patient Monitoring (RPM) has evolved rapidly over recent years as healthcare providers look for new technologically advanced ways to provide high-quality care management to growing patient cohorts without stretching resources or impacting financial viability. But what is RPM medical billing?

What is RPM medical Billing?

RPM medical billing integrates technology, including wearables, apps, and various remote monitoring devices, to monitor a patient's vital signs and overall health condition, and subsequently generate invoices for the service provided. This simultaneously provides enhanced patient outcomes and care whilst opening up new revenue streams for private practices.

The Centers for Medicare and Medicaid Services (CMS) continues to launch new Current Procedural Terminology (CPT) codes to support efficient, accurate RPM medical billing and assist healthcare services in submitting timely claims to log the correct reimbursements.

However, understanding the requirements and usage conditions of the various CPT codes associated with RPM programs and ensuring your claims are precise and cover all services provided is essential to extracting maximum benefit from your outpatient service.

What Documentation and Records Are Needed for RPM Billing?

As with any new healthcare treatment or service, practitioners and physicians need to ensure they have the right administrative infrastructure to log the services they have delivered to each patient and can provide documentation on request to support the claims submitted.

While each CPT code has different parameters and terms, most are billed once per month, with a standard requirement for every claiming healthcare service to have recorded 20 minutes of patient care management or therapy – including at least one live interaction with the patient.

Time tracking is, therefore, important, ensuring that any audits or inspections will verify that the 20-minute threshold has been met. That might include patient communications, data reporting, assessments, or remote monitoring activities.

Example RPM Billing Requirements for CPT 99453

If a healthcare provider were claiming reimbursement for CPT 99453, they would require records showing the following:

· The device identification code and the practitioner's order.

· The conditions, symptoms, or diseases being monitored.

· The date the device was delivered to the patient and the date training was provided.

These documentation requirements may vary, with CPT codes available for patient care, monitoring the measurements recorded with an RPM device, and the initial setup and patient instruction.

Who Can Submit a Reimbursement Claim for an RPM Service?

Healthcare providers should note that RPM services can be ordered or prescribed by any qualified or certified healthcare professional, including nurse practitioners, specialists, and physician assistants.

Depending on the nature of the RPM program and the CPT code being claimed, it may also be possible to delegate the service provision to a nurse or care coordinator under the supervision or instruction of a physician or other appropriate clinician.

We will look at outsourcing shortly, but the CMS will accept RPM reimbursement claims submitted by an approved third party, where medical providers use a turnkey RPM solution to manage their program and revenue cycle.

Exploring Key CPT Codes Used in RPM Billing

The norm is for a CPT code for an RPM service to be billed only once or once per month. The initial device setup is claimable only once, provided the patient has submitted 16 daily readings as instructed.

Below, you'll find the most common CPT codes and the average reimbursement rates:

· CPT 99453: used when an RPM device has been set up, and the patient has been educated about how and when to use the device. The average reimbursement rate, depending on the area, is $19.

· CPT 99454 refers to the monthly remote monitoring service, assessing the readings submitted by the patient. A minimum of 16 measurements per 30 days is required, with an average reimbursement of $50.

· CPT 99457: this code is used to claim reimbursement for treatment and management services, spanning at least 20 minutes a month and with one live interaction between the healthcare service's clinical staff and the patient. Reimbursements are, on average, $48 each 30 days.

· CPT 99458 applies to each additional 20 minutes of treatment or healthcare management services only when CPT 99457 has already been claimed. The claimable reimbursement is $39 on average.

Some slight nuances apply, where CPT 99454 is billable once every 30 days, but CPT 99457 can be claimed once per calendar month. Creating efficient billing cycles and CPT code capture may be important to avoid rejected claims or missed reimbursements.

Can Healthcare Providers Outsource RPM Billing Functions?

Many healthcare providers are opting to outsource their RPM programs to free up greater capacity to deliver supplementary services and consultations while ensuring RPM healthcare is running smoothly and responding to any flags that require immediate medical intervention.

One of the primary advantages of a remote patient monitoring solution is that it expands the reach of a healthcare service, helping it monitor and manage the treatment and care planning for more patients while utilizing existing resources and clinical expertise.

Advanced monitoring devices can be deployed quickly, with proven reductions in healthcare costs due to vastly reduced hospitalizations and readmissions, with practitioners able to see quickly if a patient has indications of a worsening condition or potential medical emergency.

Wanda Health is a highly experienced specialist provider of RPM devices and technology, such as our virtual care platform. Patients and physicians can use the platform to integrate with Electronic Health Records (EHRs), track readings and metrics, and see real-time information about how their measurements are changing.

Outsourcing allows a medical service provider to implement RPM almost immediately while relying on established billing processes to raise accurate, eligible, and compliant reimbursement claims, adhering to every requirement set by the CMS.

How Does Outsourced RPM Medical Billing Work?

RPM billing services ensure medical professionals can focus their time on patient care while logging all services or interactions that are eligible for a suitable CPT claim. This process augments the revenue cycle while reducing errors or missed claims due to time pressure or a lack of administrative capacity.

In the rare instance that a billing claim is denied or a compliance issue is raised, our RPM experts can identify the problem and resolve this quickly – even where previous refusals have originated due to incorrect coding mistakes.

Implementing robust controls and protocols to track the time spent on individual patient care, recording interactions and consultations, and understanding the requirements of each CPT code can provide a positive boost to your cash flow, providing further opportunities to expand RPM programs and enhance the levels of quality care available to your patients.

For more information about RPM medical billing, or if you’re looking to open up new revenue streams for your private practice, get in touch with Wanda Health today.


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