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New Changes on Affecting How CMS Bills for RPM Remote Patient Monitoring – Part Two

Every physician understands the challenges of working with CMS and their cost codes . Any slight error or miscoding can result in the loss of thousands of dollars in revenue. It’s vitally important that you and your team fully understand CMS, their cost codes, and the changes that occur.

While aspects of Remote Patient Monitoring have been around for decades, it was only added to CMS codes in 2016. In 2020, right before the COVID-19 pandemic started, CMS increased reimbursements to encourage physicians to utilize the service.

As was discussed in our previous post, CMS just tweaked the rules again. 

As a result, there could be confusion on what exactly can be charged as part of Remote Patient Monitoring.

The team at Medek RPM are experts at not only providing the most advanced system of Remote Patient Monitoring with the highest level of service but also in helping you navigate CMS’ billing systems for Remote Patient Monitoring.In part one, we went through some of the recent changes about Remote Patient Monitoring CMS released in December 2021. Here is a continuation of explanation on the changes, explained for physicians. 

  • After the COVID-19 public health emergency ends, 16 days of data every 30 days must be collected and transmitted to meet the requirements.
    One of the key elements of our service is our case managers. They will closely monitor a physician’s patients not just for health, but for participation. 
    Once a patient agrees to Remote Patient Monitoring, they are encouraged to participate in their monitoring every day – not just every other day. If they miss days, our case managers reach out to find them. This rule only applies to chronic illnesses. Acute care, which was added to the available care, does not require 16 days of data. 
  • Only physicians and non-physician practitioners who are eligible to furnish E/M services may bill RPM services.
    Our Medek RPM clinical review team who will be working with your patients are only physicians and non-physician providers, such as ANRP, RN, and PAs. This, gives you the peace of mind that you can bill for these services, and your patients are being handled with true professionalism. 
  • RPM services may be medically necessary for patients with acute conditions as well as patients with chronic conditions.
    This change may affect the use of Remote Patient Monitoring more than any other. When first released, Remote Patient Monitoring was specifically developed for chronic illnesses, like COPD, diabetes, and obesity. With this new change, you can provide your patients with scales, oximeters, and glucose machines, among others, for short-term illnesses too. 
  • From CMS – An “interactive communication” is a conversation that occurs in real-time and includes synchronous, two-way interactions that can be enhanced with video or other kinds of data.  We further clarified that the 20-minutes of time required to bill for the services of CPT® codes 99457 and 99458 can include time for furnishing care management services as well as for the required interactive communication.
    This change was among the most confusing because it seemed as if CMS was requiring Remote Patient Monitoring to spend 20 minutes with each patient in order for billing to qualify. CMS since made sure the last line was added to address that. A physician does not need to spend 20 minutes with the patient as that 20-minute time frame includes all the time it takes for Medek RPM to provide case management services for each patient. At Medek, our clinical team can perform the required interactions between you and your patients.

The team at Medek RPM is ready to answer any questions you might have on these rule changes as we spend a significant amount of time understanding the rules and making sure you maximize your opportunities for better outcomes and increased revenue.

If you have any questions or would like to see how Remote Patient Monitoring can improve your patient care and increase your revenue, please reach out to us today.

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