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Why is (almost) no one billing for remote patient monitoring?

June 21, 2019
Health IT
By Harry Soza

Did you know that there are eight CPT codes that could generate potentially millions of dollars of annual revenue for your organization without significantly changing provider workflows — and that would also help you deliver better care? The Centers for Medicare and Medicaid Services’ (CMS) remote patient monitoring (RPM) codes are here: however, very few organizations seem to know about them, and even fewer are taking advantage of them.

RPM codes appear to be the best-kept revenue-generation secret in healthcare today. Perhaps the main reason the codes have not been more fully embraced is the misconception that phone calls to patients are required. Trying to get a patient on the phone is difficult and the calls can be time-consuming, but the fact is that RPM codes do not require phone calls. Rather, RPM can be delivered through electronic means, such as patients’ mobile devices, to communicate and share data, which significantly reduces providers’ time commitment and workflow disruption.

Perhaps another RPM concern among providers is being flooded with irrelevant information from patients they are monitoring. However, with the right type of mobile-enabled RPM (mRPM) platform, providers can tightly control the amount and frequency of information collected, so it’s concise and clinically meaningful, while also not a reporting burden on patients.

By launching an mRPM program, healthcare organizations can grow a significant new revenue stream. Moreover, they can improve care quality by capturing and analyzing timely and relevant data that they can use to improve chronic condition management, avoid emergency department visits, ensure safe recoveries, and bring about overall better outcomes.

The lesser-known RPM codes
Perhaps the most well-known RPM codes (99490, -487, -489) were introduced in January 2015 as part of CMS’s Chronic Care Management (CCM) service, which allowed providers to bill non-face-to-face care for patients with two or more chronic conditions. Although most patient communication in the early years of the CCM program did involve phone calls, the CMS specification allows, and even encourages, providers to use electronic communication methods as well.

Even with traditional telephone-based RPM, CMS still saved $74 per beneficiary per month from 2015 through 2016, according to a comprehensive study of the CCM program. In that time, CMS also reimbursed $105.8 million to participating physicians.

Encouraged by these results, in 2018, CMS unbundled a 16-year-old code, 99091, as a separately billable service for “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.” This code does not require treatment of a chronic condition and can run concurrent with the 2015 CCM codes.

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