Connecting Patients and Providers: The Impact of RPM on Modern Healthcare
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Discover how RPM is revolutionizing modern healthcare, empowering providers to deliver proactive care, and enhancing patient outcomes. Our comprehensive infographic dives into the key benefits, including improved patient engagement, cost reduction, and better chronic condition management. Download it now to explore how RPM is shaping a smarter, more connected healthcare system.
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Remote patient monitoring programs are a win-win for primary care practices and the patients they serve. Billing for remote patient monitoring generates additional revenue for medical practices that allows providers to improve their quality of care. To successfully bill for RPM services, you’ll need to know the various CPT codes associated with RPM services and understand how different insurers reimburse for these services. This article covers each RPM billing code individually, explaining how and when to use it, and concludes by reviewing RPM coverage guidelines for patients on Medicare and private insurance.
Remote Patient Monitoring Billing Codes and How to Use Them
Accurate insurance billing is one of the most important ingredients to running a profitable primary care practice. Knowing how and when to use RPM CPT codes will enable you to fully bill for all allowable RPM services, ensuring a more robust and reliable revenue stream.
CPT 99453
Use CPT 99453 to bill for the initial setup of connected health devices used to monitor patient health parameters like respiratory flow rate, blood pressure, and pulse oximetry. Services under this code include device set-up and patient education on the proper use of equipment. The 2022 national average for Medicare reimbursement when using this billing code is $18.48 per patient for a one-time initial setup.
CPT 99454
Use CPT 99454 to bill for at least 16 days of remote patient monitoring services per 30-day period. This code requires that the RPM device supply readings or deliver programmed alerts that transmit during at least 16 days within the 30-day period. The 2022 national average for Medicare reimbursement when using this billing code is $55.77 per patient per month, or $668.64 per patient annually.
CPT 99457
CPT 99457 is used to bill for remote physiologic monitoring treatment management services of 20 minutes or more of a clinical staff/physician/other qualified healthcare professional time. In order to use this billing code, there must be at least one interactive communication between the patient and their healthcare provider per month. The 2022 national average for Medicare reimbursement when using this billing code is $50.18 per patient per month, or $602.16 per patient annually.
CPT 99458
CPT 99458 carries the same description and requirements as CPT 99457 but allows providers to bill for a second interactive communication during the month being billed. The 2022 national average for Medicare reimbursement when using this billing code is $40.84 per patient per month, or $490.08 per patient annually.
Medicare Insurance Guidelines for RPM Services
The Centers for Medicare and Medicaid Services (CMS) have four requirements for practice billing for remote patient monitoring services. Documenting that these guidelines have been followed will streamline the reimbursement process and ensure you have adequate proof that these requirements were followed.
Patient copay amount
CMS requires that patients covered under Medicare Part B be charged a 20% copayment. Choosing to waive these copayments may result in federal fines for providers.
Patient consent
Providers must gain consent from patients to provide remote patient monitoring services. This consent can be provided prior to delivering the service, either verbally or in writing.
Required monthly monitoring duration
In order to bill CMS for remote patient monitoring services, patients must be monitored for at least 16 days per billing period. Health data collected by remote patient monitoring devices can be wirelessly synced for evaluation by the patient’s provider.
RPM service must be ordered by a physician or other healthcare provider
In order to initiate patient participation in a remote patient monitoring program, RPM must be ordered by the patient’s doctor or other qualified health professional. These individuals could include a nurse practitioner, certified nurse specialist, or a physician assistant.
State Medicaid Coverage for RPM Services
Patients covered by state Medicaid programs are often eligible for remote patient monitoring programs. In fact, according to the Center for Connected Health Policy (CCHP), over half of state Medicaid programs will provide reimbursement for RPM. Since every state administers its own Medicaid program, guidelines and coverage restrictions vary. This comprehensive resource from CCHP lists the remote patient monitoring policies for each state Medicaid program.
Commercial Insurance Coverage for RPM Services
Commercial insurance providers have embraced remote patient monitoring technology. This trend toward greater coverage was accelerated during the height of the COVID-19 pandemic and hasn’t shown signs of slowing. As a result, the vast majority of private health insurers now reimburse for remote patient monitoring services for eligible patients covered under one of their policies.
Grow Your RPM Program with Withings Health Solutions
Withings Health Solutions is an industry leader in remote patient monitoring. Our FDA-approved medical-grade devices feature intuitive, patient-friendly designs that create higher levels of user engagement. Withings RPM, an all-in-one remote patient monitoring solution, comes with an AI-powered digital assistant that lets participants engage more fully.
Additionally, practices can automatically record time spent on patients for streamlined claim creation. With Withings RPM, you can grow your practice by easily tracking time spent on the platform by your practice to bill CPT codes and get reimbursed for remote patient monitoring. You can also automatically track the time spent monitoring patient measurements to build comprehensive, CMS-compliant billing reports. The solution also builds audit reports to ensure that your RPM records are audit-proof. You can have all RPM services charges automatically uploaded directly into your EHR, ready for submission.
Our experienced support team makes starting a new remote patient monitoring program easy. Withings Health Solutions handles all of the onboarding and managing support, so your care teams can focus on what matters most, providing high-quality care to patients.
Learn more about Withings Health Solutions for remote patient monitoring.
Remote patient monitoring (RPM) programs are beneficial for both patients and medical practices. But an RPM initiative’s success depends on the people behind the program. In this article, we look at why RPM programs have become so popular and the roles and responsibilities of an RPM team. To close, we share five easy-to-implement strategies for creating a strong RPM program.
Why RPM is Growing
The adoption rate of remote patient monitoring has grown dramatically in recent years. According to Insider Intelligence, 30 million patients in the U.S. will be using at least one RPM device by 2024. Here are six significant catalysts driving the rapid adoption rates of RPM technology.
COVID-19 pandemic
With much of the country brought to a standstill, the COVID-19 pandemic rapidly accelerated already emerging trends in virtual care. More insurers began covering telehealth services, dramatically increasing adoption. Remote patient monitoring devices allow medical professionals to monitor their patients’ key health metrics without having them come into the office, making RPM a significant value-add to a practice’s telehealth services.
Increase in chronic conditions such as diabetes
As the rates of long-term conditions such as heart disease, diabetes and obesity continue to rise in the U.S., remote patient monitoring devices empower patients and providers. RPM devices actively monitor key health metrics like blood pressure and weight, and the devices can be set to send data to the patient’s physician. These capabilities give patients and providers the longitudinal information they need to make changes that improve health outcomes.
Convenience
Work, family, and other obligations can quickly crowd out a schedule. RPM devices make it easy for patients to quickly take vital measures like blood pressure and weight. These measures can be automatically transmitted to the healthcare provider via cellular, WiFi, or Bluetooth connection and are instantly accessible to the patient via an easy-to-use mobile app.
Higher levels of patient care
Remote patient monitoring devices enable more frequent health measurements. With access to near real-time health data and the ability to observe historical trends in this data, healthcare providers can make better-informed care recommendations and treatment decisions.
Expand care to more diverse patient groups
For many patients, work schedules, child care or eldercare obligations, distance, or lack of reliable transportation are formidable barriers to receiving care. Low income, elderly, and patients living in underserved or rural areas can receive outsized benefits from participating in a remote patient monitoring program since it can reduce the number of office visits needed.
New revenue streams for healthcare practices
Because many RPM services are billable, RPM programs are a source of additional revenue, allowing practices to tap into new revenue streams that can improve overall profitability.
Key RPM Program Team Members
Building a strong, sustainable remote patient monitoring program requires teamwork and a shared vision. The following team members form the core of a successful remote patient monitoring program.
Top-level management
Beginning any new initiative requires the strong support and buy-in of top-level management. Healthcare executives play a key role in securing funding and staff resources, as well as providing the long-range vision needed to set a new remote patient monitoring program on a secure footing.
Physicians
Physicians can reap substantial benefits from using remote patient monitoring technology with their patients. With a wealth of patient health data, providers can make better-informed treatment decisions. Educating providers on benefits, obtaining their buy-in, and offering focused training on how to access remote patient monitoring data are essential for success.
IT support
The support of the IT department is crucial for ensuring that the technical aspects of creating and running a remote patient monitoring program are executed. Some remote patient monitoring providers like Withings Health Solutions handle most of the IT-related setup, freeing your tech support staff to focus their efforts elsewhere.
Patient navigator
Patient navigators help patients access and use their devices, troubleshooting issues that prevent them from making the most out of participating in a remote patient monitoring program. These staff members are one of the most critical components, providing front-line support and encouragement to patients as they become familiar with their new devices. Some connected devices, like those Withings Health Solutions offers, are intuitive and easy to use, making the jobs of patient navigators much simpler.
Digital health staff trainer
Staff trainers are responsible for training physicians and other practice staff involved in the program’s administration. Key topics for training include how to access and interpret patient data via the physician data dashboard and the correct use of RPM billing codes for payer reimbursement.
Medical billing representative
Medicare and many private insurers will pay for certain patient services provided via remote patient monitoring programs. Remote patient monitoring programs have their own unique set of billing codes, and the medical billing representative will ensure that the correct codes are being used on all claims filed.
Program coordinator
The remote patient monitoring program coordinator is responsible for overseeing the overall health of the program, managing the interactions between team members, troubleshooting patient and provider issues, and assessing program success based on predefined goals.
5 Tips for creating a stronger, more sustainable RPM program
Remote patient monitoring programs require careful planning and diligent follow-through during implementation in order for patients, providers, and practices to realize the full range of potential benefits this technology has to offer. These five tips can help you and the patients you serve get the most out of remote patient monitoring.
Clarify RPM program goals
First, defining what expect your remote patient monitoring program to accomplish. Clear goals not only sharpen the team’s focus but provide an objective set of criteria with which to measure program success.
Quantify expected cost/revenue metrics
Remote patient monitoring programs must be financially sustainable. Quantifying anticipated program costs and revenue enables teams to determine expected ROI. These metrics can justify the time and capital investments required for a successful launch. RPM can reduce overall costs, as it enables physicians to take preventative measurements before a condition becomes severe.
Engage the support of internal stakeholders
Top-level management, providers, and office support staff all have an important role to play in the success of a remote patient monitoring program. Gaining their support upfront is critical. If stakeholders aren’t engaged, program performance will suffer.
Invest the resources needed for program success
Engaging key personnel is an essential ingredient for ensuring long-term success, so additional staff members may need to be hired. Dedicating a program manager to oversee the effort ensures program continuity and provides a single point of contact for other team members when issues arise. Patient navigators are front-line workers who ensure patients are familiar with their devices and responsible for removing barriers to consistent use. Fortunately, the cost of hiring may be offset by billing and reimbursement for RPM services and/or lowered costs if the practice is part of a value-based care system.
Select a high-quality RPM provider to partner with
Some remote patient monitoring providers are better than others. Invest the time to research each potential partner, ensuring they offer higher quality, patient-friendly devices that are easy to use, an intuitive patient-facing health data app, and a streamlined practice-level program dashboard. The ideal RPM provider will have substantial industry experience and a track record of providing superior customer service.
Withings Health Solutions and Withings RPM: an All-in-One RPM Solution
Withings Health Solutions is committed to transforming the lives of healthcare consumers and professionals through beautifully simple monitoring solutions. Here’s how we make implementing a successful remote patient monitoring program seamlessly simple.
Effortless onboarding — Onboard your patients directly from the platform in 3 minutes or less.
Time-efficient monitoring — You’ll appreciate the one-click patient triaging through standard alerts and measurement plans.
Automatic time logging — Time spent taking care of your patients (when reviewing their charts or calling them) is automatically documented to streamline claim creation while maximizing revenue. Time spent outside the platform can easily be manually logged as well.
Optimized billing — In real-time, assess how much a CPT code can be billed and identify which patients to focus on. At the end of the month, generate comprehensive reports in one click to create claims including the CMS1500 information required for the billing.
Program dashboard — Manage your practice at a glance. A comprehensive dashboard allows care teams to view patients’ status, take action based on patient vitals and treatment plans, and easily bill for care rendered.
Patient application — The patient application allows the patient to visualize their measurements history, progress, and measurements objective. Login is simple and doesn’t require any signup or app download.
EHR integration — Withings RPM integrates with virtually every EHR to improve each step of the clinical workflow from device ordering to billing.
Learn more about Withings Health Solutions for remote patient monitoring.
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Accessing a patient’s key health metrics remotely was something few healthcare providers could envision just a few decades ago. Today, this technology is readily available, with medical-grade health devices collecting and securely transmitting patient health data directly to physicians. Remote patient monitoring (RPM) programs offer many benefits for both patients and healthcare providers. Let’s explore how this technology can provide higher-quality care for patients while improving the profitability and sustainability of medical practices. We’ll also share a quick checklist you can use to decide if starting a remote patient monitoring program is the right choice for your patients and practice.
How a Remote Patient Monitoring Program Benefits Patients
Connected health devices can be used to monitor important health stats like blood pressure, heart rate, weight, sleep patterns, and more. Many patients get a lot out of participating in a remote patient monitoring program, including those who are managing chronic conditions (i.e. diabetes, hypertension), going through post-op recovery, or who live in a rural community or lack access to reliable transportation. Here are six specific ways RPM programs benefit patients.
Higher levels of patient engagement
One of the most important factors in improving patient health outcomes is engagement. Patients who are actively engaged in their own care are more likely to proactively engage with their healthcare providers and take charge of adjusting lifestyle factors that may be impacting their overall health. Remote patient monitoring technology puts actionable health information within easy reach, allowing patients and their care providers to view both current health metrics as well as trends over time.
Greater patient ownership of health outcomes
Remote patient monitoring connects patients with their own health metrics, allowing them to play a greater role in monitoring their health. Health data is displayed on an intuitive app that allows patients to track progress over time. Easy access to health data empowers patients to see how they can improve their health by adjusting lifestyle factors within their control.
Improved access to care
Patients may face many barriers when it comes to accessing medical care. Long commutes, work and childcare obligations, and a lack of reliable transportation are just a few of the roadblocks to overcome. And in rural communities, the closest provider may be hundreds of miles away. Remote patient monitoring technologies can be used as part of a holistic health program to offer more convenient care when and where patients need it.
Additional data to better inform treatment and early detection of health conditions
In-person visits provide just a snapshot in time of key health metrics like weight, heart rate, and blood pressure, and because these measurements are taken infrequently and in an abnormal environment, these measurements may paint an inaccurate picture of a patient’s health. Remote patient monitoring devices, in contrast, can collect readings much more frequently and can be set to alert providers when numbers indicate the presence of health issues that require urgent attention.
Reduced patient cost for monitoring chronic health conditions
Actively monitoring chronic health conditions can place a significant logistical and financial burden on patients who must make frequent visits to their healthcare providers, since these visits require time off of work as well as transportation-related expenses. Participating in a remote patient monitoring program enables physicians to collect key health data remotely, potentially reducing the number of required in-person visits.
Improved quality of care
Remote patient monitoring can result in significant improvements in the quality of care that patients receive. As noted above, it provides a valuable source of additional health data for providers, leading to more informed care. More frequent readings can enable earlier detection of critical health issues that require timely intervention, and can help physicians catch deteriorating conditions before they become problematic. They also provide a more holistic view of a patient’s health. Additionally, when patients have immediate access to their own health data they can be more motivated to make important lifestyle changes and take a more active role in their health outcomes.
How a Remote Patient Monitoring Program Benefits Primary Care Practices
Launching a remote patient monitoring program can unlock a host of benefits for primary medical practices. For providers seeking to improve the quality of patient care, boost revenue, and remain competitive, offering remote patient monitoring can help accomplish these goals.
Improved quality of care and patient oversight
Remote patient monitoring technologies measure health metrics with much greater frequency than in-office visits and allow healthcare professionals the ability to spot sudden changes that may require time-sensitive intervention. For example, with an RPM program, physicians can track weight as part of fluid management in patients with CHF.
Longitudinal care
Tracking patient health trends over time provides physicians and other healthcare professionals with valuable trend data that can be used to better manage patient care. For example, providers can more easily see how a chronic illness has progressed over time with a quick glance at a data chart.
Opportunities to expand the patient base
Now that remote patient monitoring technologies have matured, patients are starting to recognize the value and convenience of enrolling in one of these programs. The proliferation of wearable technology, such as the ScanWatch, has contributed. Establishing a robust remote patient monitoring program in your practice can attract new patients eager for the advantages it can provide.
Increased patient satisfaction
Remote patient monitoring programs result in happier patients. That’s no surprise. This technology enables patients to avoid unnecessary office visits, spend more time at work or home, and access their own health data with a few clicks of a mobile app. Research backs up this assertion. A 2021 study found that 91% of post-discharge COVID-19 patients monitored remotely using a pulse oximeter would recommend it to others.
Improved profitability for the practice
Remote patient monitoring can result in more efficient workflows, boosting the productivity of office staff and healthcare providers and enabling more patients access to care. RPM programs include several billable services reimbursable by Medicare and private insurers.
Checklist to Identify if an RPM Program Is Right for Your Practice
Although remote patient monitoring programs have a lot to offer, some patients and medical practices will benefit from them more than others. Here are a few important questions to ask when deciding if launching a remote patient monitoring program is the right move for your practice.
Would your current patients benefit from this technology?
Do a significant number of your patients have chronic health conditions such as hypertension, heart failure, COPD, or diabetes?
Do a significant number of your patients have health conditions requiring short-term monitoring such as those recovering from an acute condition like severe illness, injury, or a recent hospitalization?
Do some of your patients struggle to keep frequent in-person visits due to living in remote locations, lack of transportation, or schedule conflicts due to work or primary caregiver obligations?
Is your practice eager to expand billable services and take on additional patients?
Do you have adequate buy-in from office staff and physicians?
Withings Health Solutions Makes Starting an RPM Program Simple
Starting a remote patient monitoring program from scratch can feel like a daunting task. That’s why partnering with the right remote patient monitoring provider is so important. Every healthcare provider has been through the pain of technical integrations that take far more time and money than planned. Withings Health Solutions understands the challenges, and we know that everyone has different needs and processes. This is why we offer carefully designed data connection solutions for devices and RPM. During program setup, Withings Health Solutions handles all the onboarding and manages support, freeing your team to focus on patients, not managing tech.
With over a decade of industry experience, Withings Health Solutions offers medical-grade devices that feature intuitive designs that encourage high user adoption and retention rates, including a sleep tracking mat, remote blood pressure cuff, and smart scale. Our patient-facing Health Mate mobile app puts health data within easy reach, displaying it in a way that’s personalized and easy to understand. Our physician data dashboard offers intuitive, continuous access to all your patients’ critical health data in near-real time so you can provide better care to your patients. When you’re ready to launch your remote patient monitoring program, we’re ready to help.
Learn more about Withings Health Solutions for remote patient monitoring.
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Remote patient monitoring programs are a win-win for primary care practices and the patients they serve. Billing for remote patient monitoring generates additional revenue for medical practices that allows providers to improve their quality of care. To successfully bill for RPM services, you’ll need to know the various CPT codes associated with RPM services and understand how different insurers reimburse for these services. This article covers each RPM billing code individually, explaining how and when to use it, and concludes by reviewing RPM coverage guidelines for patients on Medicare and private insurance.
Remote Patient Monitoring Billing Codes and How to Use Them
Accurate insurance billing is one of the most important ingredients to running a profitable primary care practice. Knowing how and when to use RPM CPT codes will enable you to fully bill for all allowable RPM services, ensuring a more robust and reliable revenue stream.
CPT 99453
Use CPT 99453 to bill for the initial setup of connected health devices used to monitor patient health parameters like respiratory flow rate, blood pressure, and pulse oximetry. Services under this code include device set-up and patient education on the proper use of equipment. The 2022 national average for Medicare reimbursement when using this billing code is $18.48 per patient for a one-time initial setup.
CPT 99454
Use CPT 99454 to bill for at least 16 days of remote patient monitoring services per 30-day period. This code requires that the RPM device supply readings or deliver programmed alerts that transmit during at least 16 days within the 30-day period. The 2022 national average for Medicare reimbursement when using this billing code is $55.77 per patient per month, or $668.64 per patient annually.
CPT 99457
CPT 99457 is used to bill for remote physiologic monitoring treatment management services of 20 minutes or more of a clinical staff/physician/other qualified healthcare professional time. In order to use this billing code, there must be at least one interactive communication between the patient and their healthcare provider per month. The 2022 national average for Medicare reimbursement when using this billing code is $50.18 per patient per month, or $602.16 per patient annually.
CPT 99458
CPT 99458 carries the same description and requirements as CPT 99457 but allows providers to bill for a second interactive communication during the month being billed. The 2022 national average for Medicare reimbursement when using this billing code is $40.84 per patient per month, or $490.08 per patient annually.
Medicare Insurance Guidelines for RPM Services
The Centers for Medicare and Medicaid Services (CMS) have four requirements for practice billing for remote patient monitoring services. Documenting that these guidelines have been followed will streamline the reimbursement process and ensure you have adequate proof that these requirements were followed.
Patient copay amount
CMS requires that patients covered under Medicare Part B be charged a 20% copayment. Choosing to waive these copayments may result in federal fines for providers.
Patient consent
Providers must gain consent from patients to provide remote patient monitoring services. This consent can be provided prior to delivering the service, either verbally or in writing.
Required monthly monitoring duration
In order to bill CMS for remote patient monitoring services, patients must be monitored for at least 16 days per billing period. Health data collected by remote patient monitoring devices can be wirelessly synced for evaluation by the patient’s provider.
RPM service must be ordered by a physician or other healthcare provider
In order to initiate patient participation in a remote patient monitoring program, RPM must be ordered by the patient’s doctor or other qualified health professional. These individuals could include a nurse practitioner, certified nurse specialist, or a physician assistant.
State Medicaid Coverage for RPM Services
Patients covered by state Medicaid programs are often eligible for remote patient monitoring programs. In fact, according to the Center for Connected Health Policy (CCHP), over half of state Medicaid programs will provide reimbursement for RPM. Since every state administers its own Medicaid program, guidelines and coverage restrictions vary. This comprehensive resource from CCHP lists the remote patient monitoring policies for each state Medicaid program.
Commercial Insurance Coverage for RPM Services
Commercial insurance providers have embraced remote patient monitoring technology. This trend toward greater coverage was accelerated during the height of the COVID-19 pandemic and hasn’t shown signs of slowing. As a result, the vast majority of private health insurers now reimburse for remote patient monitoring services for eligible patients covered under one of their policies.
Grow Your RPM Program with Withings Health Solutions
Withings Health Solutions is an industry leader in remote patient monitoring. Our FDA-approved medical-grade devices feature intuitive, patient-friendly designs that create higher levels of user engagement. Withings RPM, an all-in-one remote patient monitoring solution, comes with an AI-powered digital assistant that lets participants engage more fully.
Additionally, practices can automatically record time spent on patients for streamlined claim creation. With Withings RPM, you can grow your practice by easily tracking time spent on the platform by your practice to bill CPT codes and get reimbursed for remote patient monitoring. You can also automatically track the time spent monitoring patient measurements to build comprehensive, CMS-compliant billing reports. The solution also builds audit reports to ensure that your RPM records are audit-proof. You can have all RPM services charges automatically uploaded directly into your EHR, ready for submission.
Our experienced support team makes starting a new remote patient monitoring program easy. Withings Health Solutions handles all of the onboarding and managing support, so your care teams can focus on what matters most, providing high-quality care to patients.
Learn more about Withings Health Solutions for remote patient monitoring.
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