CMS recently released new CPT Codes meant for use in the reimbursement of Remote Patient Monitoring (RPM) services. In doing so, the agency proclaimed, “We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

And though they specifically mention audio/video applications, these new codes differ greatly from the previous iterations that were meant to reimburse tele-health Services that connect providers to patients using these A/V plat

The new Remote Patient Monitoring codes are specifically designed to address reimbursement for establishing RPM services, remotely collecting and transmitting health related data from patients to clinicians, reviewing the data collected and interacting remotely with the patient. More information on the specific codes can be found here, in one of my earlier blog posts.

Differences Between Tele-Health and Remote Patient Monitoring

Some of the most notable differences between what qualifies as tele-health and what qualifies as Remote Patient Monitoring are within the requirements for the visual side of contact, rural geographies and originating sites.

Unlike Tele-health, RPM does not specifically require audio/visual interaction between patients and providers and there is no requirement for patients to access or receive services in a rural area. There are also no requirements for originating sites in order to bill for RPM services. However, for RPM services to be reimbursable, patients must have a qualifying face-to-face visit with the provider within one-year prior to the beginning of services. RPM simplifies the contact aspect, noting only that providers are required to deliver 20 minutes of professional time each month which includes interactive communication with the patient or caregiver.

Partnering With Health Tech Companies to Provide Remote Patient Monitoring

The new regulations also make it easier for healthcare providers to partner with health technology companies to provide Remote Patient Monitoring services. This is because most RPM services can be provided by “clinical staff” under “general supervision” to help fulfill the 20-minute-per-month requirement for providing RPM services. With that provision in place, providers are not required to be in the same place as the staff charged with providing RPM services.

Given this autonomy, choosing the right Remote Patient Monitoring partner gives providers peace-of-mind that the staff they choose to manage RPM will have all of the training and tools necessary to provide high quality services and outstanding patient satisfaction. It also means they’ll be positioned correctly to capture the increased reimbursement possible when all of the requirements are met.

An End-to-End Solution to Improve Patient Engagement

HealthKOS is an end-to-end solution that was developed by doctors to improve patient engagement, compliance and outcomes. HealthKOS™ provides direct savings to the physician and healthcare organizations both in time and money as well as improving patient outcomes.

What makes HealthKOS™ different is that it utilizes automated algorithms, real-time data, and quality metrics to involve patients in their own care, as well as keeping healthcare providers and family constantly informed. HealthKOS™ allows the healthcare team to monitor patient progress outside the practice office, leading to timely interventions, preventing disease progression and unnecessary hospitalizations.

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New CPT Codes released by CMS in 2019 are meant to incentive providers to offer better quality Remote Patient Monitoring (RPM) services, especially for those patients diagnosed with chronic diseases. These rules also give healthcare providers greater leeway to collaborate with digital health companies to provide RPM services.

2019 RPM CPT Codes Explained

CPT 99453:  This code reimburses certain costs associated with initial device set-up and patient education on the use of devices such as blood pressure cuffs, pulse oximeters and even scales. This is necessary because patients may know how to use these devices on their own but they may not understand how to sync them to a device in order to transmit the data remotely. Reimbursement for this charge is minimal but overlooking it could cost your organization a one-time reimbursement of $21 per patient participating in a remote monitoring care plan.

CPT 99454: Allows for the reimbursement of remote monitoring of physiologic parameter(s). For example, weight, blood pressure, pulse oximetry and respiratory flow rate. This code is also meant to cover the initial supply and set-up of devices. CMS specifically noted these devices should be capable of “daily recording(s) or programmed alert(s) transmission, each 30 days.” However, most devices cannot function without a platform to help transmit the data. In addition, they may depend on software to help recognize abnormalities or declining health status and alert providers. CMS will reimburse approximately $69 per patient, per month.

CPT 99457: This code covers remote physiologic monitoring treatment management services. CMS requires 20 minutes or more of professional time from clinical staff, physicians or other qualified healthcare professionals, along with interactive communication with the patient or caregiver, each calendar month. The reimbursement for this service is approximately $59 per month.

Capturing Chronic Care Management Reimbursement

In addition to revenue generated by Remote Patient Monitoring, providing these services could be a catalyst to offering Chronic Care Management services under CPT codes 99490 and 99487 which allow for reimbursement of approximately $43 and $94 respectively. The difference is 99490 requires 20 minutes of Chronic Care Management and 99487 requires 60 minutes of Chronic Care Management. However, creating better patient engagement and acquiring a more robust and timely set of health data from Remote Patient Monitoring would help providers offer better Chronic Care Management services to their patients.

Requirements for Billing

Providers should note that there are additional requirements to bill for Remote Patient Monitoring. Three of the most important requirements are:

• Patients must be diagnosed with 2 or more chronic conditions
• The devices used to collect and transmit data must be cleared by the FDA
• RPM must be ordered by a qualified healthcare professional

An End-to-End Solution for RPM

HealthKOS™ has created an end-to-end solution that provides your organization with the tools needed to offer true remote patient management and capture the revenue generated by providing these enhanced services to your patients.

For more information on the HealthKOS Platform, or to request a demo, please contact us at 1-855-227-3567 or info@healthkos.com.

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