In 2018, Centers for Medicare & Medicaid Services (CMS) introduced CPT codes for chronic care billing and reimbursement to providers who were delivering care with remote patient monitoring software. Theoretically, this was great for providers, but CMS kept CPT codes for reimbursement very vague to allow for future adjustments, leaving the challenge for providers and organizations to clarify what remote patient monitoring services fall into the CPT codes and how to bill for them.
In January 2021, CMS released several valuable updates to the RPM reimbursement CPT codes and further clarified what the CPT codes rules are. This blog intends to break those updates down, in order to help providers receive full reimbursement for remote patient monitoring services and be encouraged to embrace RPM software without the worry of how and when to bill for their services.
By using a remote patient monitoring tool like Force Therapeutics, it can be determined that ~73% of patients would not require the 12-week follow-up based on early survey results.
What changes did CMS make in 2021 to the RPM Reimbursement CPT Codes:
Becker’s Hospital Review offers interesting insight on the three significant corrections for reimbursements and clarification of the original CPT codes for remote patient monitoring, and what this means for providers moving forward. We broke down the information from that article into a data table for easier analysis.
Here's are 3 significant corrections to the original CPT codes:
What are the benefits of these updates to the CPT codes for RPM billing?
Based on the data above, there are now clear financial incentives for providers using valuable time to onboard, communicate, and analyze data with a patient-centric remote monitoring program. Although there is still confusion around some billing due to vagueness, we expect that CMS will continue to revisit and revise the rules as remote patient monitoring software and devices evolve and continue to weave into healthcare infrastructures.
Remote patient monitoring is a relatively new concept in the healthcare industry. Historically, there has been slow movement with established insurance billing practices for technology and the time associated with implementing solutions into the organization and onboarding patients.
Now, the updated CPT codes and billing structure makes the process of logging, reporting and billing simple and clear for providers. At a time of digital innovation, home health monitoring services can be utilized to improve patient outcomes, increase patient satisfaction, and address care gaps that can be identified with collected data without the worry of how to tackle the final billing process.
Here are the benefits to the most recent CPT code clarifications/updates:
1. Interactive communications: RPM providers can now bill CMS for both interactive communications and remote care services rendered. Each 20-minute code can now comprise of chart review, care planning, and patient messaging as well as real-time audio communication.
2. 2-day and 16-day requirements: There should be less confusion around the number of measurement-days required to bill. Only those exceptions actually identified under the PHE waiver are acceptable for the 2-day requirement.
3. Number of practitioners delivering RPM services: Providers are now aware that they need to identify whether potential remote patient monitoring patients are already receiving RPM services from another provider before initiating new RPM services.
Here is the updated rule document from CMS.
Key Takeaways for Organizations and Remote Patient Monitoring Services
Providers and organizations that already have remote patient monitoring services in place should take the time to carefully evaluate their current billing model and adjust accordingly to account for this year’s changes.
Furthermore, if your organization has submitted a claim in the last year that you believe could violate the updated rules, it’ll be essential to consider the potential issues and risks associated with those claims.
For providers and organizations currently considering onboarding remote patient monitoring, you should proactively create a billing model that supports the most updated CPT codes, in order for seamless reimbursement.
In order to comply with the rules, your structured billing model should include:
- How to get each patient to opt-in for the service
- How the device will be supplied to the patient for 16 days
- How to ensure that each service is ordered by a physician or other qualified healthcare professional
- Ensure that all data is wirelessly synced where it can be evaluated
- The data-monitoring services should be performed by a provider, a qualified healthcare professional or by clinical staff at one healthcare facility.
Remote health tools that are powered by AI and machine-learning compensate for a substantial amount of otherwise manual work for care teams, reducing the need for additional hires, and enhancing the care experience that patients receive from your organization.
As pressure is applied on healthcare organizations by payers to drive down patient care costs, reduce readmission rates, and pivot to patient-centric models, remote patient monitoring solutions will continue to grow in popularity. With that being said, if your organization prepared for this industry-wide shift?
For more information on remote patient monitoring, we create a guide that breaks down what RPM is, how it will benefit your organization, and how to choose a company that is AI-enabled, patient-centric, and data-backed.
