The Centers for Medicare & Medicaid Services (CMS) provide guidelines that care providers must follow in order to be reimbursed for RPM services. Eligible CMS remote patient monitoring services must meet the following qualifications:
- The patient has a chronic or acute condition.
- There is an existing patient-provider relationship.
- The remote patient monitoring device must fit the FDA’s requirements to be considered a medical device.
- The RPM services must cover at least 16 days out of a 30 day period.
- Medical information is digitally collected then uploaded to a server that the billing practitioner can access. The server must be secure to comply with the HIPAA Security Rule.
In addition to the above guidelines for patient qualifications, physicians must also adhere to the following to receive reimbursement for RPM services:
- RPM services are only billed once during a 30 day period—no matter how many RPM devices a patient uses during this period. Remember, these services must be used for at least 16 days of a 30 day period in order for that period to be billable.
- The billing physician must provide eligible CPT codes. For Medicare, billing for RPM equipment, monitoring, and management services typically fall under these codes: 99453, 99454, 99457, 99458, and G0511.
As regulations evolve, CMS guidelines for remote patient monitoring will also change. It’s essential to maintain accurate and accessible health records to stay current with these updates.
Billing Remote Patient Monitoring Services
Only qualified physicians or their authorized representatives can bill RPM services to Medicare. Any healthcare provider eligible for Medicare billing can also bill for telehealth services, including RPM.
Coverage for RPM Devices and Management
Medicare and most major private insurers cover RPM devices, including self-monitoring blood glucose meters and blood pressure cuffs. They also reimburse for RPM management services, which include analyzing patient data and updating care plans based on new information.
CMS Requirements for Remote Patient Monitoring Reimbursement
Remote patient monitoring (RPM) devices and services make each moment count when it comes to improving health outcomes. By collecting health data in real-time, care managers can assess risks and respond proactively.
Through a combination of easy-to-use devices, remote care services, and an EHR integrated patient dashboard, TimeDoc Health users have reported the following remote patient monitoring statistics:
- 15% improvement in blood pressure control
- 90% patient retention in Virtual Care Management programs
- $167 per patient, per month in reimbursements
Fortunately for both patients and providers, remote monitoring systems can be covered by Medicare—when set up correctly.
Remote patient monitoring systems must meet specific requirements in order to be eligible for reimbursement through Medicare or other insurance providers. Specifically for remote patient monitoring CMS reimbursement, your care center’s RPM cases must meet the following qualifications:
- Condition(s): RPM can cover chronic or acute conditions. Often, this technology is used to monitor chronic conditions, such as diabetes, sleep apnea, and asthma.
- Patient-Provider Relationship: There must be an existing patient-provider relationship before the start of RPM services.
- Medical Device Characteristics: RPM equipment must meet the FDA’s definition of a medical device. Source FDA approved RPM devices from TimeDoc Health to ensure compliance with federal regulations.
- Service Duration: RPM services must monitor patient conditions for at least 16 days over a 30 day period. Only one bill can be submitted per patient, even if that patient uses multiple devices during the same period.
- Data Security and Access: The information collected by RPM devices must be transferred digitally to a secure server that the care provider can access.
- Billing Codes: RPM services must be billed using the appropriate CPT codes, which are often: 99453, 99454, 99457, 99458, and G0511.
Does Insurance Cover Remote Patient Monitoring?
In addition to Medicare, Medicaid and many major private insurance providers also cover remote patient monitoring. The Health Resources & Services Administration states that while most states offer coverage for RPM through Medicaid, the exact scope of coverage can vary state to state. You can view which telehealth services Medicaid covers, including remote patient monitoring, here. Private insurance providers also vary on their coverage of RPM, so it’s best to reach out to individual companies to learn more.
How Much Does Remote Patient Monitoring Cost?
In a study published in the National Library of Medicine, researchers estimate that for type 2 diabetes management, annual RPM implementation across the US costs $4,374,544 and ongoing costs total over $1.6 million per year. On an individual basis, RPM costs average between $21 and $29 per day, or approximately $600 to $900 per month.
With a remote patient monitoring devices list that includes costly equipment such as heart monitors and blood glucose meters, accessing these crucial services would be prohibitively expensive if not for the coverage provided by Medicare, Medicaid, or private insurance.
Meet CMS Requirements for Remote Patient Monitoring with TimeDoc Health
Using a centralized RPM system can prepare your services to meet Medicare’s requirements, which expands the pool of patients you can serve—and simplifies your practice’s billing process. With TimeDoc Health, you can benefit from a remote patient monitoring system that:
- Uses FDA approved devices
- Integrates with your existing EHR system
- Provides real-time data updates
- Allows for customizable alert settings
- Offers a team of expert care coordinators to support your staff
Time is of the essence when working towards improved health outcomes. With TimeDoc Health, your care plans can react to patient data in real-time. Schedule a demo to learn more.
