Remote Patient Monitoring
Remote Patient Monitoring (RPM) is a preventative program designed to monitor the physiologic data of patients with chronic diseases, identify problems and prevent exacerbation of their conditions.
Medicare RPM helps providers transform their practice and keep up with the radical changes in the healthcare industry. It empowers connected care by expanding care expertise beyond the traditional care setting.
Providers deliver RPM services to collect a range of patient health data including blood pressure, vital signs, weight, heart rate, blood sugar levels, and physical activity.
How Medicare RPM Works
- Medicare’s Remote Patient Monitoring or Remote Physiologic Monitoring (RPM) program uses digital devices and technology in a patient’s home to collect medical data from patients. These devices can capture metrics such as blood sugar and heart rate. The data is then electronically transmitted to healthcare providers for assessment and intervention.
- The premise of the program is that RPM technology allows providers to have a more frequent and comprehensive view of the vital signs associated with a patient’s chronic conditions like COPD, hypertension, congestive heart failure, and diabetes.
- Over the past few years, CMS has significantly revised its coverage of RPM services through the overhaul of CPT codes and an increase in payment for remote physiological monitoring services. These changes have turned RPM into one of the most lucrative Medicare care management programs.
The RPM program by CMS would significantly transform the care delivery in specialties including but not limited to
- Pain Management
- Surgical Services
Who Qualifies for Medicare Remote Physiologic Monitoring?
Although the CMS originally classified RPM for the treatment and management of chronic illness, proposed changes allow providers to evaluate and treat acute illness as well. This is especially important now, as an increasing number of patients seek care during the pandemic.
In order to qualify for coverage, the RPM device used must be reasonable and necessary for the diagnosis and treatment of the patient's condition. The device must meet FDA standards for medical devices as described in section 201(h) of the Federal, Food, Drug, and Cosmetic Act.
RPM - Efficiency & Outcomes
75% Reduced Hospital Readmission
15% Fewer Emergency Visits
90% Improved Patient Satisfaction
91% Health Outcomes were as good or better via Telehealth
Aiding the COVID-19 Fight
Medicare extension Care Management Programs help preserve healthcare system capacity for COVID-19 patients in a number of ways such as
- Decreasing the risk of virus transmission among patients, community members, and healthcare workers
- Helping patients recover at home while eliminating hospital visits or admissions
- Getting qualitative measurements of patient’s health status and disease progression
- Sending notifications to hospital staff to prepare for COVID-19 patients’ arrival
Typical Medicare RPM Cycle & Problem Statements
Upload eligible patients onto the portal Import from multiple sources such as EMR, HIS systems Difficulty in identifying eligible patients
Obtain patient consent, prior to enrolment Difficulty in triggering bulk messages/emails Inability to log minutes for SMS triggers/emails
Monitor trends from patient health data Inability to auto sync patient recorded data No proper configuration for target ranges, thresholds, or alerts
Log services & capture progress notes Manual logging of calls by Care Managers Manual attachment of care plans to patients' charts
CPT code and bill generation Applications that do not integrate/interact with each other Inability to capture accurate bills due to manual time tracking
LevelUp Remote Patient Monitoring Services
LevelUp offers a 360 degree suite of Remote Patient Monitoring services that deepen patient-provider relationships and increase practice revenue without adding overhead costs to providers. We ensure the RPM devices and technology are compliant with FDA standards.
We help providers in delivering end-to-end Medicare RPM programs and generating additional recurring revenue without overburdening their staff. Our skilled care coordinators
- Obtain patient consent prior to enrollment
- Create care assessment and communicate with patients
- Identify patients with/out device assignments
- Setup threshold and non-adherence alerts
- Interact with patients, log services and capture progress notes
- Generate CPT code and billing reports for CMS audits
Medicare RPM Reimbursement Codes
Physicians and other qualified healthcare professionals (QHCPs) can provide and bill for RPM. Clinical staff can furnish and manage RPM under the general supervision of the billing provider.
|Code||Description||Caregiver Criteria||Billing Period||Medicare Rate|
|CPT 99453||Set-up, patient instructions, and education regarding the use of RPM equipment||Must be ordered by physician or qualified health care professional (QHCP)||Billed 1x per episode of care, minimum 16 days of monitoring||$18.77 (Both non-Facility and Facility)|
|CPT 99454||Devices supply with daily recordings or programmed alerts transmission||Must be ordered by physician or QHCP||Billed for a calendar month, minimum 16 days of monitoring||$64.44 (Both non-Facility and Facility)|
|CPT 99457||RPM treatment management services, requiring interactive communication with the patient/caregiver||Performed by physician, other QHCP or clinical staff under general supervision||Billed for a minimum of 20 minutes in a calendar month||$51.61 (Non-Facility Rate) $32.84 (Facility Rate)|
|CPT 99458||Reported in conjunction with 99457 to report each additional 20 minutes of time||Performed by physician, other QHCP or clinical staff under general supervision||Billed for additional 20 minutes in a calendar month as an addon to CPT 99457||$42.22 (Non-Facility Rate) $32.84 (Facility Rate)|