Billing for Remote Patient Monitoring

Introduction

Remote patient monitoring (RPM) has become increasingly popular in healthcare, particularly with the surge in demand during the COVID-19 pandemic. To receive reimbursement for RPM services, healthcare providers must adhere to specific guidelines and requirements. Understanding the intricacies of billing for RPM is essential for accurate reimbursement and compliance. In this article, we explore valuable insights on billing for remote patient monitoring, including the necessary information for claim submission, documentation requirements, and the common CPT codes associated with RPM.

Billing for Remote Patient Monitoring

Healthcare providers seeking reimbursement for remote patient monitoring (RPM) services should take note of a few key factors. Firstly, RPM is a program that is billed on a monthly basis, and in order to qualify for Medicare reimbursement, patients must receive a minimum of twenty minutes of service per month. This time can be a combination of interactive communications, remote monitoring, and data reporting.

Furthermore, it is important to highlight that RPM services must be ordered by a physician or a qualified healthcare professional. This may include professionals such as nurse practitioners, certified nurse specialists, or physician assistants. In some cases, an RPM program may involve an initial review conducted by a care coordinator or nurse, followed by consultation with a physician for final interpretation and necessary actions.

Step-by-Step Guide: Billing for Remote Patient Monitoring

When it comes to billing for remote patient monitoring, there are specific requirements and steps that need to be followed. Here are some valuable inputs on how to bill for remote patient monitoring:

Required Information for Claim Submission

When submitting a claim through the Centers for Medicare & Medicaid Services (CMS), there are five essential items you need to include:

• CPT codes: Assign the appropriate CPT codes for each program you are managing for the patient.
• ICD-10 codes: Tie the relevant ICD-10 codes to each of the conditions you are managing within the program.
• Date of service: Include the specific date on which the remote patient monitoring services were provided.
• Place of service: Indicate the appropriate place of service code that reflects the location where the remote patient monitoring was conducted.
• National Provider Identifier (NPI) number: Provide your NPI number, which serves as a unique identifier for healthcare providers.

Documentation of Time and Device Readings

To meet CMS criteria for reimbursement of remote patient monitoring services, certain requirements must be fulfilled. These include:

• Use of certified electronic health record (EHR) technology: Ensure that you are using an EHR system that meets the necessary certification standards.
• Time spent or remote device readings: Spend at least 20 minutes per month with the patient and/or record 16 days of remote device readings. Document the time spent and the readings obtained.
• Compilation of monthly reports and summary: Create and maintain monthly reports that summarize the remote patient monitoring data collected.
• 24/7 access to care management services: Be available to provide care management services to patients 24/7.
• Tracking and sharing of RPM data: Track readings from connected devices and make the data available to the entire staff. Ensure that the RPM data is shared with the EHR and other relevant healthcare providers involved in the patient’s care.

By adhering to these guidelines and procedures, healthcare providers can effectively bill for remote patient monitoring services, ensuring proper reimbursement for the care delivered. It is crucial to stay updated on the specific requirements outlined by CMS and any additional guidelines from relevant payers to accurately and successfully bill for remote patient monitoring services.

CPT Codes for Remote Patient Monitoring

The most common CPT codes for remote patient monitoring are as follows:

• CPT Code 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial setup, and patient education on the use of equipment.
• CPT Code 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
• CPT Code 99455: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission, 30 days or more.
• CPT Code 99456: 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.
• CPT Code 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.
• CPT Code 99458: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.
• CPT Code 99459: Remote physiologic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month of at least 20 minutes, directed care to the patient/caregiver, when performed.

To conclude,

Billing for remote patient monitoring requires attention to detail and adherence to specific guidelines. When submitting a claim for reimbursement, providers must include essential information such as CPT codes, ICD-10 codes, date of service, place of service, and their National Provider Identifier (NPI) number. Documentation of time and device readings is crucial, with providers needing to use certified electronic health record (EHR) technology. By following these guidelines, healthcare providers can accurately bill for RPM services and ensure proper reimbursement.

About PrimeCare Medical Billing Services

When it comes to billing for remote patient monitoring, partnering with a reliable medical billing company can ensure accurate and timely reimbursement. One such trusted medical billing partner is PrimeCare. We understand the unique challenges associated with billing for remote patient monitoring services. From verifying billing requirements to submitting claims, our dedicated team ensures meticulous attention to detail and adherence to coding guidelines. With PrimeCare as your billing partner, you can have peace of mind knowing that your remote patient monitoring services will be accurately billed, leading to optimal reimbursement and a streamlined revenue cycle. Contact us today to learn more about our medical billing services.

The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. The AMA developed and maintains the CPT code set, regularly updating it to reflect changes in medical practices, technology, and healthcare regulations.